Online Program

Replication and hospitalization cost analysis of the community asthma initiative (CAI) program in a second neighborhood in Boston

Tuesday, November 5, 2013

Urmi Bhaumik, MBBS, MS, ScD, Office of Community Health, Boston Children's Hospital, Boston, MA
Susan J. Sommer, MSN, WHNP-BC, AE-C, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Lindsay Tsopelas, BA, Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Kerri Norris, BA, Finance, Boston Children's Hospital, Boston, MA
Shari Nethersole, MD, Boston Children's Hospital, Boston, MA
Elizabeth R. Woods, MD, MPH, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Objective: To evaluate the effect of CAI intervention in additional neighborhoods and to examine if the model is replicable.

Methods: CAI contained an intervention and a comparison community in the first 2.75 years of the program. After July 1, 2008 the comparison community was also served. In this paper, the hospitalization cost (HC) and length of hospital stay (LOS) were analyzed for this comparison population before and after receiving services. The patients were identified through the emergency department visits or hospitalization. The HC and LOS data for the enrolled CAI patients during the intervention time period were compared one year before and one year after the enrollment date using paired t tests.

Results: Overall, the background trend of increasing HC during the comparison time period was reversed to a decrease in HC that coincides with initiation of CAI services in this community in 2008. The results for the CAI patients (N =267) in the intervention period showed a decrease in HC from $4,480 per patient for one year before intervention to $961 one year after intervention (p < 0.001). LOS among CAI enrolled patients decreased from an average of 1.25 days for one year before intervention to 0.28 days one year after intervention (p < 0.001), and may explain the observed HC decrease.

Conclusion: HC and LOS in the pre-CAI services period was significantly higher than in the post-CAI period. Enrolled CAI patients showed a marked decrease in HC cost and LOS once services were provided in this community.

Learning Areas:

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

Learning Objectives:
Identify the benefits of a comprehensive community-based asthma program. Evaluate the cost effectiveness of the CAI program and its potential for replication.

Keyword(s): Asthma, Cost-Effectiveness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of Research and Evaluation for the Community Asthma Initiative at Boston Children's Hospital. I have worked closely with community health centers and programs for the last 15 years.
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.