Home visits from a nurse can both improve the health of children with asthma who live in low-income communities and cut the costs associated with hospitalization and emergency department care, according to a study published today in the journal Pediatrics.
In Massachusetts, where the study was conducted, rates of asthma in low-income urban communities are substantially higher than elsewhere in the state; 16% of children at urban schools have asthma vs 9.5% of children in schools in Massachusetts overall. Asthma is the major cause of child hospitalization at Children’s Hospital Boston, where 70% of the children hospitalized with the condition come from Boston’s low-income neighborhoods.
To identify whether a community-based intervention might help reduce hospitalizations and improve outcomes, the team of researchers from Children’s Hospital Boston and the Boston Asthma Initiative identified children who had been hospitalized or required multiple emergency department visits for asthma between 2005 and 2008, using zip codes to identify those from 4 low-income neighborhoods. The children’s families were invited to participate in the study, and about half (283) agreed to do so. A nurse coordinated the asthma care of each patient and a nurse or a nurse-supervised community health worker visited each patient’s home to provide parents with education about asthma care, to assess potential environmental triggers in the home, and to help remediate any potential contributing factors. Remediation efforts included such interventions as providing special bedding; a vacuum cleaner with a high-efficiency particulate air (HEPA) filter; and, when necessary, referral to a pest-management service.
The researchers found that 1 year after the start of the program, participating children had 68% fewer emergency department visits and 84.8% fewer hospitalizations than in the year prior. Participating children also had 41% fewer days of missed school, and their parents missed work about half as often as before the intervention. A cost-effectiveness analysis of the program also found that the program cost $2529 per child and resulted in an savings of $3827 per child in reduced hospitalizations and emergency department visits, thus saving about $1.50 per $1.00 spent.
“This is a remarkable savings to society and reflects better health outcomes for the children,” said Elizabeth Woods, MD, MPH, of the division of adolescent/young adult medicine at Children’s Hospital Boston in a statement.