Community Asthma Initiative: An innovative community-based intervention leading to policy changes

Objective: Because asthma is the leading cause of hospitalization and emergency room (ER) visits at Children's Hospital Boston, the Community Asthma Initiative (CAI) was developed to provide nurse case management, home visits, and community connections for comprehensive asthma education, thereby reducing hospitalizations, ER visits, and missed school days. Methods: Services provided included nurse case management for an individualized care plan, coordination with primary care, allergist and community resources; and home visits, including environmental assessment, integrated pest management, and asthma education. Sufficient baseline and 6-month follow-up information was available for these analyses. McNemar's test was used for dichotomous variables and paired t-test for continuous variables. Results: 124 children enrolled were a mean of 8.0 years (+/- 4.4 SD); 58% males; 40% African American, 49% Latino, 11% other; and 58 completed 6 months of follow-up. There were significant reductions in any emergency room visits (64.9% to 24.6%, p<0.001), hospitalizations (58.6% to 19%, p<0.001), missed school days (97.9% to 59.6%, p<0.001), and an increase in the number of children with a current asthma action plan (41.4% to 73.9%, p=0.001). There was a significant decrease in mean number of emergency room visits, hospitalizations, and number of missed school days (all p < 0.001). This new model of asthma care is generating information that has guided legislative advocacy efforts to improve financing of these services. Conclusion: CAI significantly decreased ER visits, admissions, and missed school days, and provides a successful model of asthma care and education that can be replicated nationally and influence policy.