The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project.
BACKGROUND
A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI).


METHODS
This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management.


RESULTS
Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25-75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882,021.


CONCLUSIONS
The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.
a Regional Asthma Disease Management Program, Mission Children's Hospital , Asheville , NC , USA .
Melinda S
MS
Shuler
b Department of Epidemiology , UNC-Chapel Hill , Chapel Hill , NC , USA , and.
Karin B
KB
Yeatts
a Regional Asthma Disease Management Program, Mission Children's Hospital , Asheville , NC , USA .
Donald W
DW
Russell
a Regional Asthma Disease Management Program, Mission Children's Hospital , Asheville , NC , USA .
Amy S
AS
Trees
c Mission Hospital, Research Institute , Asheville , NC , USA.
Susan E
SE
Sutherland
D000041:Absenteeism; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004777:Environment; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009657:North Carolina; D010353:Patient Education as Topic / Q000458:organization & administration*; D011203:Poverty; D044469:Racial Groups; D012129:Respiratory Function Tests; D012424:Rural Population; D012720:Severity of Illness Index
Education; management/control; morbidity and mortality; pediatrics; treatment