Successful School-Based Intervention for Inner-City Children with Persistent Asthma

Author： Anderson Mark Freas Michelle Wallace Andrea Kempe Allison Gelfand Erwin Liu Andrew

ISSN： 0277-0903

Source： Journal of Asthma, Vol.41, Iss.4, 2004-01, pp. : 445-453

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Abstract

Objective: Because children attend school daily, school‐based interventions for children with persistent asthma could provide effective disease management for inner‐city asthmatic children. The Kunsberg School in Denver, Colorado, enrolls children with chronic diseases, including asthma, into a daily program of school‐based disease management. This study sought to determine the impact of the Kunsberg program on asthma utilization. Methods: Children attending Kunsberg (n = 18) who received primary care at Denver Health were compared with a group of matched control children who also received primary care at Denver Health, but did not attend Kunsberg (n = 36). Asthma‐related utilization for an average of 2.9 years before and after Kunsberg enrollment was assessed. Results: The 18 Kunsberg and 36 control subjects were mostly minority children in low‐income families, without significant demographic differences between groups. Compared with controls, the Kunsberg cohort experienced fewer hospitalizations (0.5 vs. 0.9 hospitalizations/subject/year, p = 0.05), fewer emergency department (ED) visits (1.4 vs. 2.8 ED visits/subject/year, p = 0.04), and fewer follow‐up visits for asthma (3.7 vs. 5.0 visits/subject/year, p = 0.01) in the time period (mean 2.9 years; range 1–6 years) following the intervention. Hospital‐ and clinic‐based asthma utilization costs decreased 80% following enrollment in the school ($8122/year to $1588/year per child), compared to a 19% decrease in the control group. Among the Kunsberg children with hospitalizations prior to school enrollment (n = 8), hospital days decreased from 3.5 days to 0.1 days annually (p < 0.01), ED visits decreased from 2.1 to 0.6 visits annually (p = 0.02), and follow‐up visits decreased from 6.8 to 2.1 visits annually (p = 0.02). As part of their school program, 89% of Kunsberg enrollees received inhaled corticosteroids daily on a monitored basis while at school. Conclusions: The Kunsberg school program improved asthma control and reduced disease severity for at‐risk inner‐city asthmatic children, leading to cost reduction for asthma management. Directly observed controller therapy at school can be an important component of a school‐based program for children with chronic conditions.