Child/Adolescent Health

Use of nurse case managers and physician peer leaders can reduce children's asthma symptoms but at a price

A primary care program that uses nurse case managers to educate children about their asthma and physician peer leaders to educate primary care physicians on asthma treatment guidelines can reduce children's asthma symptoms. In a recent study, the program gave children an average of two additional symptom-free weeks per year, but with increased asthma care costs. The study was supported in part by the Agency for Healthcare Research and Quality (HS08368).

The Pediatric Asthma Care Patient Outcomes Research Team II (PAC-PORT II) randomized 42 primary care practices to usual care or one of two asthma care strategies to determine their impact on symptom-free days (SFDs). The two strategies were a peer leader-based physician behavior change intervention (PLE) and a planned asthma care intervention (PACI) that combined PLE with nurse managers/educators. The researchers followed a total of 638 children (age 3 to 17 years) with mild to moderate persistent asthma for up to 2 years. The difference in annual SFDs was 6.5 days for PLE versus usual care and 13.3 days for PACI versus usual care. Annual costs per patient were as follows: PACI, $1,292; PLE, $504; and usual care, $385. Compared with usual care, the incremental cost-effectiveness ratio was $18 per SFD gained for PLE and $68 per SFD gained for PACI.

These results demonstrate the feasibility of increasing SFDs in children already receiving controller medications and improving the use of recommended guidelines for asthma care. However, the results may not apply to uninsured or Medicaid-insured groups.

See "Multisite randomized trial of the effects of physician education and organizational change in chronic asthma care," by Sean D. Sullivan, Ph.D., Todd A. Lee, Pharm.D., Ph.D., David K. Blough, Ph.D., and others, in the May 2005 Archives of Pediatric and Adolescent Medicine 159, pp. 428-434.

Editor's Note: A related study of a program to improve management of children with asthma using a quality improvement collaborative model did not demonstrate a significant effect due to deficiencies in program implementation and other problems. More details are in Homer, C.J., Forbes, P., Horvitz, L., and others (2005, May). "Impact of a quality improvement program on care and outcomes for children with asthma." (AHRQ grant HS10411). Archives of Pediatric and Adolescent Medicine 159, pp. 464-460.

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