Study supports new approaches to reverse rising asthma rates
Calls for insurance coverage of educational and environmental programs to reduce asthma attacks and hospitalizations and improve quality of life
July 6, 2007
A study commissioned by the Asthma Regional Council of New England (ARC), and supported by Children's Hospital Boston, finds that there is a compelling health and economic case for investing in prevention-oriented programs that emphasize patient education and in-home controls of environmental triggers of asthma. The study was conducted by the University of Massachusetts Lowell's (UML) Environmental Health Initiative.
The study -- Investing in Best Practices for Asthma -- found that effective patient asthma education led to fewer emergency room visits, fewer hospitalizations, improvement in the quality of life and lung function of patients, and fewer lost school and work days. It also showed that many of these outcomes can translate directly into substantial costs savings, especially when targeted to high risk asthma patients.
"This study indicates that current approaches to managing asthma--which rely primarily on encouraging compliance with medications--are not working for a lot of people," says Laurie Stillman, director of ARC. "It shows we can improve asthma outcomes in a cost effective manner if high risk patients are provided with additional education and environmental improvements in the home."
The study calls for health insurers to pay for asthma care that extends beyond physician office visits, which they typically don't cover. It also includes three case studies of health plans that currently cover asthma education and environmental interventions, delivered by professionals who are not physicians. These programs decreased asthma-related hospitalizations and emergency room visits, and realized significant net cost savings. In New England, some local Medicaid Managed Care plans are already beginning to invest in similar programs.
"We found cost savings ranging from more than $7 for every $1 invested in asthma education to as high as $36 for every $1 invested," says UML researcher Polly Hoppin, PhD. "Our review of the published literature concludes that we can reduce health care costs by providing patients and families with asthma education programs above and beyond what a clinician typically covers in a sick or well visit. Further, these programs can effectively be provided by professionals other than physicians."
"Effective asthma management requires action in four areas: proper medication, regular monitoring of lung function, asthma education and environmental controls," adds Hoppin. "These last two areas can make the difference in someone with asthma leading a healthy active life, yet they are often neglected, both by practitioners and by insurers."
The study determined that in-home environmental interventions specifically--including home assessments, education and providing supplies, such as mattress and pillow covers, pest abatement and vacuums with HEPA filters--can be provided at a reasonable cost while reducing environmental exposures that can trigger attacks. Limiting these exposures led to improved health outcomes for asthma patients, including fewer days with asthma symptoms, fewer urgent care visits to a physician and reduced use of "rescue" medications.
"It is challenging for me as a physician to provide comprehensive education in a brief office visit and even more daunting for children and families to absorb all of this information at one time," says Shari Nethersole, MD, medical director for Community Health at Children's Hospital Boston. "Follow-up education sessions and in-home assessments are needed to reinforce key points, identify triggers in the home and assist families in complying with their medical treatment plan."
The newly-formed Massachusetts Asthma Advocacy Partnership (MAAP) believes this study will help their coalition partners argue for improvements in asthma care in the state as well. "Too many families are struggling with the effects of asthma because they aren't being given the tools to better manage a complicated disease," says Jean Zotter, executive director of MAAP. "Massachusetts has large racial and economic disparities in health outcomes for asthma, which result, in part, from lack of insurance coverage for asthma education and services for this population. This study supports a more sensible way for managing a disease that disproportionately affects low income communities."
The Asthma Regional Council was established seven years ago by the New England federal offices of the U.S. Department of Health and Human Services, the Environmental Protection Agency and HUD to improve asthma outcomes in the region. It is located in Boston and is a program of The Medical Foundation.
Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: www.childrenshospital.org/newsroom.