title: Integrating asthma education and smoking cessation for parents: financial return on investment.
abstract: BACKGROUND
  Caregivers who smoke and have children with asthma are an important group for intervention. Home-based interventions successfully reduce asthma morbidity, yet are costly. This study evaluated the financial return on investment (ROI) of the Parents of Asthmatics Quit Smoking (PAQS) program, a combined asthma education and smoking cessation intervention.
  
  
  METHODS
  Participants included caregivers (n = 224) that smoked, had a child with asthma, and were enrolled in a Medicaid managed care plan. Participants received nurse-delivered asthma education and smoking counseling in three home visits. Program implementation costs were estimated, and healthcare expenses were obtained from insurance claims data 12 months pre- and 12 months post intervention. ROI was calculated for all participants, children <6 years, children 6-18 years, and children with moderate/severe persistent asthma.
  
  
  RESULTS
  Total program implementation cost was $34,481. After intervention, there was increased mean annual refills of beta-agonist (0.51 pre, 1.64 post; P < 0.001), and controller medications (0.65 pre, 2.44 post; P < 0.001). Reductions were found in mean annual emergency department visits (0.33 pre, 0.14 post; P < 0.001), hospitalizations (0.23 pre, 0.08 post; P < 0.001), and outpatient visits (2.33 pre, 1.45 post, P < 0.001). The program had negative ROI (-21.8%) for the entire sample. The ROI was positive (+106.9) for children <6 years, negative (-150.3) for children 6-18, and negligible for moderate/severe persistent asthma (+6.9%).
  
  
  CONCLUSIONS
  PAQS was associated with increased medication use and decreased healthcare utilization. While the overall ROI for PAQS was negative, PAQS had a positive ROI for caregivers of young children with asthma.
authors.affiliation: Bradley/Hasbro Children's Research Center, Alpert Medical School, Brown University, Providence, Rhode Island. elizabeth_mcquaid@brown.edu
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: McQuaid
authors.forename: Aris
authors.initials: A
authors.lastname: Garro
authors.forename: Ronald
authors.initials: R
authors.lastname: Seifer
authors.forename: S Katharine
authors.initials: SK
authors.lastname: Hammond
authors.forename: Belinda
authors.initials: B
authors.lastname: Borrelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D002648:Child; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D010290:Parents / Q000193:education*; D012720:Severity of Illness Index; D016540:Smoking Cessation / Q000191:economics*; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents