OBJECTIVES: 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.
OBJECTIVES: 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: Mary R Janevic; Shelley Stoll; Margaret Wilkin; Peter X K Song; Alan Baptist; Marielena Lara; Gilberto Ramos-Valencia; Tyra Bryant-Stephens; Victoria Persky; Kimberly Uyeda; Julie Kennedy Lesch; Wen Wang; Floyd J Malveaux Journal: Am J Public Health Date: 2016-09-15 Impact factor: 9.308
Authors: Margaret E Samuels-Kalow; Matthew W Bryan; Marilyn Sawyer Sommers; Joseph J Zorc; Carlos A Camargo; Cynthia Mollen Journal: Pediatr Emerg Care Date: 2020-02 Impact factor: 1.454
Authors: Robin S Everhart; Suzanne E Mazzeo; Rosalie Corona; Rachel L Holder; Leroy R Thacker; Michael S Schechter Journal: Contemp Clin Trials Date: 2020-08-19 Impact factor: 2.226
Authors: Barbara P Yawn; Peter C Wollan; Matthew A Rank; Susan L Bertram; Young Juhn; Wilson Pace Journal: Ann Fam Med Date: 2018-03 Impact factor: 5.166
Authors: Stefan G Kertesz; Erika Laine Austin; Sally K Holmes; David E Pollio; Joseph E Schumacher; Bert White; Carol VanDeusen Lukas Journal: J Gen Intern Med Date: 2014-12 Impact factor: 5.128
Authors: Zhao Dong; Anjali Nath; Jing Guo; Urmi Bhaumik; May Y Chin; Sherry Dong; Erica Marshall; Johnna S Murphy; Megan T Sandel; Susan J Sommer; W W Sanouri Ursprung; Elizabeth R Woods; Margaret Reid; Gary Adamkiewicz Journal: Am J Public Health Date: 2017-11-21 Impact factor: 9.308