Bilingual Community-Based Asthma Education for Latino Families Appears to Offer Substantial Medical Economic Cost Savings: The Children's RESPIRA Education Program

We developed a bilingual program for Latino families with children with asthma in northern NJ, because our clinical experience indicated many parents were not adequately aware of how to manage their children's asthma, nor were children receiving the most appropriate medical services. Debuting in late 2006, it features initial educational sessions on asthma for Latino families in Spanish and/or English (as families' needs dictate), with home visits scheduled ~3 and ~9 weeks thereafter (actual range: 2.3-18.3 weeks and 7.3-23.9 weeks, respectively).

One goal was to assess changes in health care resource utilization before and after training. Families are therefore asked on intake about asthma-related emergency department visits, in-patient hospital admissions for asthma, and doctor visits for asthma attacks or worsening of asthma symptoms during the previous year. At each follow-up, they are asked about their use of these same health care resources since joining the program. Using intake and follow-up dates, we computed the rates over time of each of these resource utilizations.

During the first 14 months, 166 families including 201 children were enrolled (enrollment rates approached 20 per month under full staffing); some have dropped out, leaving a total of 140 families and 164 children who completed the program or remain actively enrolled. 76% of intake interviews were in Spanish.

Person-time intensity analysis of reported utilization of these three health care resources shows families, while enrolled, dramatically reduced utilization, especially of costly hospitalizations. Mean last follow-up through 31-Jan-2008 is 10.8 weeks after enrollment. Reported annual rates of hospital admissions dropped from 0.755 in the year before enrollment to 0.097 from enrollment to the last follow-up, an 87% reduction (p < .00001). Rates of emergency department visits dropped from 1.453 to 0.646, a 56% reduction (p < .0001), and rates of doctor visits for asthma dropped from 2.709 to 1.324, a 51% reduction (p < .00001). Using an estimated cost of $4,000 per hospital admission and estimated charges of $600 per emergency department and $80 per doctor visit, the estimated direct healthcare system cost savings from this educational intervention amount to $3,228 per child, or a total of $774,666 per year if 20 children enter the program monthly with full staffing and if the decreased utilization rates are maintained for a year. To evaluate whether the program in fact leads to sustained changes in health and in health care utilization, we are adding a one-year follow-up assessment.