A randomized controlled trial of a pediatric asthma outreach program

J Allergy Clin Immunol. 1999 Mar;103(3 Pt 1):436-40. doi: 10.1016/s0091-6749(99)70468-9.


Background: Previous studies have shown that asthma education and case management may reduce asthma emergency care, hospitalizations, and expenditures.

Objective: We sought to study the effect of an asthma outreach program (AOP), a team-based, case-management intervention, on emergency ward (EW) and hospital use.

Methods: Fifty-seven patients aged 1 to 15 years with the diagnosis of asthma based on the usual clinical practice criteria who were continuously enrolled in a staff-model health maintenance organization for a period of at least 2 consecutive years were randomized into 2 intervention groups. The control group received a single intensive asthma education intervention, and the AOP group received the same initial education but then was followed-up by an asthma case management nurse throughout the intervention period.

Results: EW visits, hospitalizations, and total outside-of-health-plan expenditures (consisting of EW and hospital expenses, as well as miscellaneous costs, such as ambulance, durable medical equipment, tertiary referrals, and home care) were assessed from claims filed for a year before and after enrollment. Control group patients experienced significant reductions in EW visits (39%), hospitalizations (43%), and outside-of-health-plan costs (28%), possibly as a result of the baseline educational intervention received by all enrolled patients, in conjunction with regression to the mean. AOP group patients experienced significant reductions in EW visits, (73%, P =.0002), hospitalizations (84%, P =.0012), and outside-of-health-plan use (82%, P <.0001). When compared with the control group, AOP group patients demonstrated additional significant reductions in EW visits (57%, P <.05), hospitalizations (75%, P <.05), and outside-of-health-plan use (71%, P <.001). Estimates of direct savings to the health plan ranged from $7.69 to $11.67 for every dollar spent on the AOP nurse's salary, depending on assumptions.

Conclusions: Asthma patients in a staff-model health maintenance organization decreased their resource use between 57% to 75% by participation in an AOP as compared with a randomized control group receiving only an educational intervention. Substantial savings were achieved compared with the cost of the AOP nurse.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asthma / economics
  • Asthma / nursing
  • Asthma / psychology
  • Asthma / therapy*
  • Boston
  • Case Management / economics
  • Case Management / organization & administration*
  • Child
  • Child, Preschool
  • Community-Institutional Relations*
  • Cost of Illness
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data*
  • Ethnic Groups
  • Female
  • Health Expenditures
  • Health Maintenance Organizations / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Nurses / economics
  • Patient Care Team / economics
  • Patient Education as Topic* / economics
  • Program Evaluation
  • Salaries and Fringe Benefits