Care Management for Childhood Asthma: What Works?

Abstract

Introduction:

Care management focuses on improving coordination of care and improving health-related behaviors for identified, at-risk populations. There have been relatively few studies of care management interventions that used randomized controlled clinical trial design. These studies have yielded discrepant results.

Methods:

Randomized controlled studies of asthma care management interventions were identified and summarized. Common themes of beneficial and nonbeneficial programs were identified.

Results:

The randomized clinical trials that did show benefit targeted low-income, inner-city patients with poorly controlled asthma and incorporated in-person plus telephone visits. Several programs provided services to reduce asthma triggers in the home; programs that did not show benefit targeted populations with relatively high levels of adherence to inhaled corticosteroid and did not provide resources (other than advice) for environmental remediation. One study that failed to show benefit had a fragmented, subcontracted care management process that was not connected to the child’s medical home. Innovative programs that showed benefit in randomized studies and deserve replication include use of community health workers for home visits and school-based asthma care management.

Conclusions:

Asthma care management is beneficial in some, but not all populations. The most benefit was seen in populations with under-treated, poorly controlled asthma. Fragmented, subcontracted care management programs that were not community-based and not connected to the child’s medical home were not beneficial. A care management process that involved both in-person visits and telephone follow-up and provision of resources for reduction of asthma triggers in the home were components of successful programs.