Home visits for asthma: a win for both patients and payers

Marquis and his mother (middle) received educational home visits from Children’s nurse manager Massiel Ortiz

The journal Pediatrics released a study from Children’s Hospital Boston that shows a preventative approach to treating asthma can keep kids out of the Emergency Department (ED) and save money on health care spending.

The study is based on data collected by Children’s Community Asthma Initiative (CAI), which has been working closely with low-income residents of Boston with asthma since 2005. By sending nurse practitioners and community health workers into the homes of families whose children are frequently hospitalized for asthma, Children’s staff was able to identify asthma triggers in the families’ homes and offer education on avoiding them.

For example, a mother who cleans every inch or her home but then places the broom and duster back in the closet could still be exposing her child to asthma inducing mites. Trained CAI staffers, many of whom have asthma themselves, teach participants the proper way to clean a house to fully remove dust and other potential asthma triggers like pest droppings and mold. The program also provides special coverings for bedding and vacuum cleaners with specific, asthma fighting filters, free of charge.

After 12 months in the program, the children had a 68 percent decrease in asthma-related ED visits and an 85 percent drop in hospitalizations. There was a 43 percent reduction in the percentage of children who had to limit physical activity on any day, a 41 percent reduction in reports of missed school days and a 50 percent reduction in parents having to miss work to care for their child.

In addition to improving quality of life for young asthma sufferers, enrollment in the CAI has substantial financial benefits as well. When CAI patients were compared with nonparticipating children from four similar communities, the CAI saved $1.46 in medical fees for every dollar spent on prevention. The program cost $2,529 per child, but yielded a savings of $3,827 per child because of reduced ED visits and hospitalizations.

“This is a remarkable savings to society and reflects better health outcomes for the children,” says by Elizabeth Woods, MD, MPH, of the Division of Adolescent/Young Adult Medicine at Children’s and co-leader of CAI.

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

“We expect that the new payment models will incorporate these expanded education and home-visiting services and allow for more comprehensive care for children with high-risk asthma,” says Shari Nethersole, MD, of the Office of Child Advocacy at Children’s and co-leader of CAI.

To learn more about the Community Asthma Initiative please read this story about how the program helped Marquis Lewis take control of his asthma. To speak with a member of the CAI staff, visit their website.

  • Theron Knapp

    What should be done with broom and dust pan to prevent mites?

    • trippunderwood

      Hi Theron, I forwarded your question to a member of our CAI team. Here’s her response: “In order to control dust in an apartment, especially if someone has asthma or allergies, we would generally recommend you avoid sweeping, since sweeping doesn’t do a good job picking up a lot of the fine dust particles, like dust mites, pollen, etc. In fact, sweeping tends to just stir them up. If someone is not able to buy a HEPA vacuum, then we would suggest damp mopping or using a micro-fiber mop, which will pick up the dust more effectively.”

      Hope that helps.