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Social worker-based intervention reduces symptom days and is cost effective for inner city children with asthma

Children living in urban areas with high levels of poverty and large minority populations are disproportionately at high risk for avoidable asthma-related illness and death. The National Cooperative Inner-City Asthma Study (NCICAS) shows that a comprehensive program that includes social worker-based asthma education and control of environmental asthma triggers can reduce asthma symptoms for a modest increase in costs among inner city children, especially those with more severe asthma, according to Peter J. Gergen, M.D., M.P.H., of the Agency for Healthcare Research and Quality.

After a baseline assessment of about 1,000 children (age 5-11 years) with physician-diagnosed asthma, Dr. Gergen and his colleagues randomly assigned them either to the asthma counselor (AC) or usual care (UC) group. The researchers followed the children's clinical outcomes and use of health care services for 2 years.

In the AC group, asthma counselors coordinated asthma care and helped families identify and control environmental asthma triggers such as smoke, animals (including pets and cockroaches), and dust mites. The ACs also encouraged families to obtain and understand the asthma care plan from their primary care physician (PCP), helped them improve communication with their PCPs, and facilitated referrals to appropriate community resources for smoking cessation, psychologic counseling, housing problems, and health insurance.

Over the 2-year period, the AC group had an average of 27 more symptom-free days than the UC group (565 vs. 538). However, there were no significant differences between the groups in rate of scheduled and unscheduled physician visits, hospital admissions, and ED visits. The mean cost of providing the AC program was about $337 per child over the 2 years, of which about 33 percent was for personnel expenses, with remaining expenses for medical devices, materials, skin tests, and cockroach extermination visits. When compared with usual care, the AC program improved outcomes at an average additional cost of $9.20 per symptom-free day gained, similar to that of established medication interventions.

See "The cost-effectiveness of an inner-city asthma intervention for children," by Sean D. Sullivan, Ph.D., Kevin B. Weiss, M.D., M.P.H., Henry Lynn, Ph.D., and others, in the October 2002 Journal of Allergy and Clinical Immunology 110, pp. 576-581.

Reprints (AHRQ Publication No. 03-R006) are available from the AHRQ Publications Clearinghouse.

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