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Asthma initiative has impact on health care use
ANN ARBOR—Children living in areas where there was wide-ranging and active support for improving outcomes for their chronic asthma were hospitalized less and made fewer visits to the emergency room, when compared with those in other communities.
The need for costly health care services was reduced in six low-income communities that had participated in a special initiative to improve pediatric asthma control, led by faculty and staff at the Center for Managing Chronic Disease at the University of Michigan School of Public Health.
A team of researchers, headed by Noreen Clark, the Myron E. Wegman Distinguished University Professor of Public Health and director of the center, examined health care utilization by low-income children ages 2-18, from 2002-06. The team was interested in finding out how the Allies Against Asthma initiative, established in 2002 with support from the Robert Wood Johnson Foundation, had an impact on use of hospital in-patient units, emergency rooms and urgent care centers.
"Pediatric asthma is the most prevalent chronic disease of childhood and is exceedingly costly in both direct and indirect expenses to the health care system and families," said Dr. Laurie Lachance, evaluation director of the center. "Our study is the first that we know of to link work of coalitions with significant outcomes for children with asthma community wide."
Nationwide, nearly 20 million people suffer from the condition, and 6 million of them are children and adolescents, according to the Centers for Disease Control and Prevention.
The results of the team's research are reported in the April issue of the American Journal of Public Health in an article titled, "Improvements in Health Care Use Associated with Community Coalitions: Long Term Results of the Allies Against Asthma Initiative."
Allies Against Asthma brought together established asthma organizations, health care leaders, health departments, and local community and volunteer organizations to work on policy, care coordination, environmental issues and education. The goals were to improve health status and reduce health care utilization, in children and teens with asthma.
"When a community works together, we can make a real difference in the health of all of our children. This study greatly expands our understanding of the power of using community coalitions to effect change," said Dr. Talmadge King, chair of the Department of Medicine at the University of California, San Francisco, a member of the Allies Against Asthma advisory board.
The communities with Allies Against Asthma programs included Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA. The researchers compared Medicaid records from cities with similar populations, both in size and other demographic features, in Roanoke City, VA; Jacksonville, FL; Everett, Lacey, Olympia, and Tacoma, WA; National City and San Bernardino, CA; Baltimore, MD; Lorain, Ohio; Muskegon, Detroit, and Flint, MI; and Fort Wayne and Indianapolis, IN.
"When change is created in systems and policies, long lasting improvements result for the whole community," Clark said. "This study shows that community coalitions are significant engines of such change."
Additional U-M researchers involved were Amy Friedman Milanovich, Shelley C. Stoll, and Margaret Wilkin, all with the SPH Center for Managing Chronic Disease, and Peter X. K. Song, Department of Biostatistics.
Other authors represented the Centers for Medicare & Medicaid Services, Health and Human Services, Baltimore, MD; W. K. Kellogg Foundation, Battle Creek; DC Asthma Coalition, Washington, DC; Eastern Virginia Medical School Children's Hospital of The King's Daughters, Norfolk; Seattle & King County and the Department of Health Services; University of Washington School of Public Health, Seattle; RAND Health, Santa Monica, CA; Medical College of Wisconsin and Children's Hospital and Health System, Milwaukee; The Children's Clinic, Long Beach, CA; and the Department of Family and Community Medicine, Christiana Care Health Systems, Wilmington, DE.
- For a pdf of the American Journal of Public Health article, contact Kimberly.Short@apha.org
- The Center for Managing Chronic Disease: http://cmcd.sph.umich.edu/
- Clark: http://www.sph.umich.edu/iscr/faculty/profile.cfm?uniqname=nmclark
- U-M School of Public Health: http://www.sph.umich.edu/
- Contact Laurel Thomas Gnagey