The Positive Impact of a Disease Management Program on Asthma Morbidity in Inner-City Children

Objectives of this study were to investigate whether implementing an asthma disease management program that involves the interplay of a physician in an asthma clinic, and periodic home visits by non-physician members of this program, could reduce asthma morbidity in disadvantaged inner-city children with moderate to severe asthma. Records of 142 children (6 ± 4 years) enrolled into the program for at least one year were reviewed. Seventy-six (54%) were black, while 61 (43%) were white. No mortalities were observed during the period of study. There was a significant reduction in the number of hospital admissions: 1.2 ± 0.11 (mean ± SEM) vs. 0.5 ± 0.1 episodes (p < 0.05), length of stay on pediatric floors: 3.2 ± 0.5 vs. 1.4 ± 0.38 days (p < 0.05) and in the pediatric critical care unit: 0.8 ± 0.2 vs. 0.2 ± 0.09 days (p < 0.05) 1 year after enrollment into the program. There was also a reduction in the proportion of the number of missed school days (35% vs. 12%, p < 0.01) and days with restricted activities (35% vs. 13%, p < 0.001) one year after enrollment into the program compared to the previous year. There were no significant changes in the number of children who visited the emergency department one year after enrollment into the program. Introduction of an asthma disease management program to disadvantaged innercity children with moderate to severe asthma may reduce resource utilization and improve quality of life in this high-risk group of children with asthma.