Evaluation of nurse case management: Implications for pediatric asthma care

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.