Online Program

Evaluation of nurse case management: Implications for pediatric asthma care

Wednesday, November 6, 2013

Rachel Lum Ho, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Madeline Bundy, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Emily Feinberg, ScD, CPNP, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Low-income, minority and inner city child populations are disproportionally burdened by asthma, a leading cause of chronic childhood illness and disability in the U.S. Despite the existence of established asthma guidelines and quality indicators, disparities in asthma outcomes persist. We evaluated the impact of nurse case management on asthma outcomes for children with persistent asthma who received care at a community health center in an underserved Boston neighborhood. Quality indicators of asthma care were abstracted by chart review from a cohort of 189 patients with persistent asthma from 2008-2011. Asthma nurse case management began in April 2009. Thus, data captures asthma care outcomes pre and post implementation. The cohort was 34% Black, 31% Asian, 17% White and 18% Other; 56% male; and the mean age was 12 years. Over 30% identified a preferred language other than English- 25% Vietnamese, 5% Spanish, and 1% Portuguese. We analyzed change in proportion of children who received guideline concordant asthma care pre and post asthma case management implementation. Results show improvements in several indicators: updated inhaled steroid prescriptions increased from 72% to 84%; at least one annual asthma-specific clinical visit (exclusive of annual physical exam) increased from 55% to 68%; an Asthma Action Plan on record increased from 77% to 95%; and having 1 or more asthma-related ED visits decreased from 15% to 12%. Annual rates of flu vaccination did not change. Further investigations of the cost effectiveness of this promising model asthma case management are warranted.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related nursing

Learning Objectives:
Describe the impact of an asthma nurse case manager on clinical outcomes for children with persistent asthma at a community health center. List methods to retrospectively evaluate the effects of a nurse case manager on clinical care in a community health center. Discuss opportunities to apply the principles of nurse case management to other primary health care challenges.

Keyword(s): Asthma, Case Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was a research fellow supported by MCHB leadership in public health training grant. I conducted this research, investigating the effect of nurse case management on pediatric asthma outcomes as part of my fellowship. I completed my Masters in Public Health, Maternal and Child Heath, in May 2013 at Boston University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.