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Pediatric asthma case management: A review of evidence and an experimental study design

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Abstract

Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.

Section snippets

Editor’s introduction

The following article is a “blueprint” for an evidence-based research study. There are many levels of evidence to consider when making decisions regarding best practice. The randomized controlled trial is considered a gold standard for best research evidence. This randomized controlled trial is being implemented to determine whether a nursing intervention, nursing case management, is cost-effective and whether it makes a significant difference to children with asthma and their families.

Case management programs

Case management, as defined by The Case Management Society of America, is “a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes” (CMSA, 2002). Case management programs have been shown to be effective in managing children with chronic complex health care needs (Rossi, 1999). A meta-analysis of educational programs aimed at

Randomized controlled trials of nurse case management

Rigorous studies of nurse case management can be found in three randomized controlled trials (Table 1). Greineder, Loane, and Parks (1999) investigated an asthma outreach program, which used a nurse case manager for 57 HMO patients between 1 and 15 years old. Patients in the control group received asthma education and usual care, whereas the intervention group received asthma education and case management, including home visits, a written asthma plan, family-centered treatment goals, and

ED Allies asthma follow-up intervention study and Fight Asthma Milwaukee (FAM) Allies program

There is evidence to support nurse case management of pediatric asthma, although more randomized control trials with larger sample sizes need to be done to show the cost-effectiveness of various models of nurse case management. Fight Asthma Milwaukee (FAM) Allies coalition is conducting a randomized controlled study that aims to improve self-management, home environmental safety, and quality of life of children with asthma and their families. The program’s goal is to enroll 560 children with

Acknowledgements

The authors gratefully acknowledge the following individuals for their contribution to this article: Kris White, RN, BSN, BSW, City of Milwaukee Health Department, and Linda Kritikos, RN, BSN, MPH, Gentiva Health Services. We also thank research collaborators at the Medical College of Wisconsin, Chris Walsh-Kelly, MD, and Marc Gorelick, MD, MSCE, for their leadership of the complementary ED Allies Asthma Follow-Up Intervention Study.

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    Supported by two grants from The Robert Wood Johnson Foundation Allies Against Asthma program and the Managing Pediatric Asthma: Emergency Department Demonstration Project, to the Children’s Health and Hospital System. Also supported by a grant from the State of Wisconsin Tobacco Prevention, Research, and Education Program to the Medical College of Wisconsin.

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