title: Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care.
abstract: OBJECTIVE
  The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work.
  
  
  METHODS
  Urban, low-income patients with asthma from 4 zip codes were identified through logs of ED visits or hospitalizations, and offered enhanced care including nurse case management and home visits. QI evaluation focused on parent-completed interviews at enrollment, and at 6- and 12-month contacts. Hospital administrative data were used to assess ED visits and hospitalizations at enrollment, and 1 and 2 years after enrollment. Hospital costs of the program were compared with the hospital costs of a neighboring community with similar demographics.
  
  
  RESULTS
  The program provided services to 283 children. Participants were 55.1% male; 39.6% African American, 52.3% Latino; 72.7% had Medicaid; 70.8% had a household income <$25 000. Twelve-month data show a significant decrease in any (≥1) asthma ED visits (68.0%) and hospitalizations (84.8%), and any days of limitation of physical activity (42.6%), patient missed school (41.0%), and parent missed work (49.7%) (all P < .0001). Patients with greatest functional impairment from ED visits, limitation of activity, and missed school were more likely to have any nurse home visit and greater number of home visits. There was a significant reduction in hospital costs compared with the comparison community (P < .0001), and a return on investment of 1.46.
  
  
  CONCLUSIONS
  The program showed improved health outcomes and cost-effectiveness and generated information to guide advocacy efforts to finance comprehensive asthma care.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, MA 02115, USA. elizabeth.woods@childrens.harvard.edu
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
authors.forename: Urmi
authors.initials: U
authors.lastname: Bhaumik
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Sommer
authors.forename: Sonja I
authors.initials: SI
authors.lastname: Ziniel
authors.forename: Alaina J
authors.initials: AJ
authors.lastname: Kessler
authors.forename: Elaine
authors.initials: E
authors.lastname: Chan
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Wilkinson
authors.forename: Maria N
authors.initials: MN
authors.lastname: Sesma
authors.forename: Amy B
authors.initials: AB
authors.lastname: Burack
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Klements
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Queenin
authors.forename: Deborah U
authors.initials: DU
authors.lastname: Dickerson
authors.forename: Shari
authors.initials: S
authors.lastname: Nethersole
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003191:Comprehensive Health Care / Q000458:organization & administration*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population