Improving the health and daily lives of children with asthma

DSCN0658Wheezing, shortness of breath, multiple medications, missed school days, and frequent hospital visits are the challenges nearly seven million U.S. children face when managing asthma.

Since 2005, Boston Children’s Hospital’s Community Asthma Initiative (CAI) has worked with over 1,000 families to help them better manage their child’s asthma. The goal is threefold: to increase a child’s quality of life; reduce Emergency Department (ED) visits and hospitalizations; and save money on asthma-related health care spending, which adds up to over $3.2 billion a year nationwide.

How CAI works

CAI nurses and community health workers go outside of hospital walls and into the homes of Boston families whose children are frequently hospitalized or seen in the ED for asthma.

“Connecting with families soon after an emergency department visit or hospitalization is a critical time to help them better understand their child’s asthma, improve asthma control and help connect them back to their primary care providers,” says Elizabeth Woods, MD, MPH, director of the CAI and associate chief of the Division of Adolescent/Young Adult Medicine at Boston Children’s.

Assessing a child’s environment first-hand allows CAI staff to not only develop a close relationship with the family but gives them a chance to pinpoint possible asthma triggers and offer advice on how to remedy them. The CAI staff partners with each family and helps parents carry out a treatment plan based on their unique situation and child’s health care needs.

Staff will also determine barriers that may prevent a child from receiving appropriate care or medications and will link families to resources that make asthma management easier.

“Our goal is to help families become active members of their child’s asthma team so that children can go to school, play and sleep through the night without being limited by their asthma,” says Susan Sommer, MSN, WHNP-BC, AE-C, clinical director of CAI.

The program also provides allergen-proof bedding encasements and vacuum cleaners with special HEPA filters, which help reduce exposure to common asthma triggers in the home.

CAI shows positive results

DSCN0816Within 12 months of signing up, children in the program had 57 percent fewer ED visits and 80 percent fewer hospitalizations.

Children prone to missing school due to their asthma saw a 43 percent drop in missed school days and parents missed 51 percent fewer days of work to care for the children.

In addition to improving quality of life for children with asthma, enrollment in the CAI has substantial financial benefits as well.

Originally, the program cost $2,529 per child, with a savings of $3,827 per child due to a reduction in ED visits and hospitalizations. Now, with the nurse-supervised community health worker model, the cost has been reduced to $2,060 per child served, with an average of one other child or adult in the family living with asthma who may have improved symptoms.

“This is a remarkable savings to society and reflects better health outcomes for the children,” says Dr. Woods.

Expanding the asthma intervention conversation

Based on program success, the CAI is working with Massachusetts Medicaid and other health care payers to develop a new payment system for asthma care that mirrors many aspects of the CAI’s approach to asthma prevention.

Furthering the asthma conversation, Dr. Woods presented CAI findings to a national audience this month at the Brookings Institution, a nonprofit public policy organization based in Washington, DC.

“We are particularly excited to work with our primary care partners to develop a new model that can provide sustainable funding for enhanced asthma education, home visits and care in the community,” Dr. Woods says.

Learn more about Boston Children’s upcoming Pediatric Asthma and Allergy Updates for the Primary Care Provider CME.