Clinical practice columnPediatric asthma case management: A review of evidence and an experimental study design☆
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.
References (23)
- et al.
Managing betterChildren, parents, and asthma
Patient Education & Counseling
(1986) - et al.
A randomized clinical trial to reduce asthma morbidity among inner-city childrenResults of the National Cooperative Inner-City Asthma Study
Journal of Pediatrics
(1999) Asthma among minority childrenA growing problem
Chest
(1992)- et al.
A randomized controlled trial of a pediatric asthma outreach program
The Journal of Allergy and Clinical Immunology
(1999) - et al.
The cost effectiveness of an inner-city asthma intervention for children
Journal of Allergy and Clinical Immunology
(2002) - et al.
Enhancing medication adherence among inner-city children with asthmaResults from pilot studies
Journal of Asthma
(2002) - et al.
An individualized intervention to improve asthma management among urban Latino and African-American families
Journal of Asthma
(2002) - et al.
Use of community health workers with inner-city children who have asthma
Clinical Pediatrics
(1994) Standards of Practice for Case Management
(2002)AsthmaAim to be symptom free
(2003)
Lay health advisor intervention strategiesA continuum from natural helping to paraprofessional helping
Health Education and Behavior
Cited by (17)
Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions
2016, Journal of Allergy and Clinical Immunology: In PracticeEvaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial
2016, International Journal of Nursing StudiesCitation Excerpt :Most self-management programs (Ahmad and Grimes, 2011; Welsh et al., 2011) emphasize only a caregiver's responsibility of monitoring adherence to treatment and not a comprehensive family care approach to address relieving parental stress or increasing family function (Horner, 1995). For successful management, a case manager should consistently and patiently meet with the family to build a trusting relationship (Schulte et al., 2004). The major responsibility of paediatric nurses is providing holistic family-centred nursing care to improve family function (Kuhlthau et al., 2011) and to maintain a well-controlled asthma regimen for children to have normal growth and development.
The development and descriptions of an evidence-based case management educational program
2011, Nurse Education TodayCitation Excerpt :Case management is increasingly being adopted as a care delivery model around the world as evidence suggests that it is associated with a range of positive outcomes (Barton et al., 2004; Schein et al., 2005; Schulte et al., 2004).
Case Study of a Transtheoretical Case Management Approach to Addressing Childhood Obesity
2008, Journal of Pediatric NursingInner-city asthma the role of the community
2007, ChestCitation Excerpt :Thus, even if single allergen exposure such as mite allergens were reduced, it is possible that high levels of other exacerbants would render the single interventions ineffective. Previous intervention trials31,32 designed to decrease asthma severity in underserved populations have tended to rely on professional case management focused on multifaceted interventions. The strongest results seen so far were in the National Cooperative Inner-city Asthma Study,33 in which 515 children age 5 to 11 years in active case management by masters-level social workers reported significantly less symptom days in the previous 2 weeks than the control group (3.51 days vs 4.06 days).
- ☆
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.