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A Win for Both Patients and Payers
Marquis and his mother (middle)
received educational home visits
from Children’s nurse manager
Massiel Ortiz; © Harvard University
The CAI is a community-based asthma care model targeting low-income families. It includes nurse case management and care coordination combined with home visits by a bilingual nurse or Community Health Worker to educate families about asthma, assess the home for asthma triggers, and provide materials and services to improve the home environment, such as encasements for bedding, HEPA vacuums and pest control.
The CAI team, led by Doctor Elisabeth Woods of the Division of Adolescent/Young Adult Medicine and Doctor Shari Nethersole of the Office of Child Advocacy at Children's Hospital Boston, selected children from four low-income zip codes for the intervention because they had been hospitalised or had made emergency department (ED) visits for asthma. Of 562 eligible children identified, 283 families agreed to participate.
At enrollment, 43 per cent of participating children had asthma scored as moderate or severe. Families received an average of 1.2 home visits during the year-long program. "The environmental issues have been much greater than expected, with high rates of pest infestation and dust and mold problems," Woods says.
After 12 months in the program, the children had a 68 per cent decrease from baseline in asthma-related ED visits and an 85 per cent drop in hospitalisations. There was a 43 per cent reduction in the percentage of children who had to limit physical activity on any day, a 41 per cent reduction in reports of missed school days and a 50 per cent reduction in parents having to miss work to care for their child. The percentage of children with an up-to-date asthma care plan rose from 53 per cent at baseline to 82 per cent at 12 months.
All of these improvements were evident within 6 months, and, among children who had follow-up, persisted for as long as two years.
The quality improvement intervention yielded a significant return on investment: When CAI patients were compared with nonparticipating children from four demographically similar communities, the CAI saved 1.46 Dollar for every dollar spent. The program cost 2,529 Dollars per child, but yielded a savings of 3,827 Dollars per child because of reduced ED visits and hospitalisations. "This is a remarkable savings to society and reflects better health outcomes for the children," says Woods.
"Our experience with CAI allowed us to work with community partners to develop a business case for reimbursement of these services by insurers," adds Nethersole.
MEDICA.de; Source: Harvard University