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Children’s Hospital reports progress on asthma

Program cuts costs, trips to ER

Kayana Szymczak for the Globe

Chanese Brown and her son Thomas, who just went on his first out-of-state school trip.

Hospitalizations for asthma have been dramatically cut by a program that helps families reduce the conditions that trigger attacks, saving $1.46 in hospital care for every $1 spent on prevention, according to a Children’s Hospital Boston study being released today.

The hospital’s program, the Community Asthma Initiative, targeted 283 children with asthma in some of Boston’s poorest neighborhoods. Health workers taught families how to correctly use medications and eliminate triggers of attack, such as contaminated bedding and feather dusters. They also provided each family a vacuum cleaner with special filters.

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After the first year, asthma-related emergency room visits for children in the program plummeted 68 percent compared with their emergency room trips in the year before enrolling, and there was an 85 percent drop in hospitalizations, according to the study published online in the journal Pediatrics.

Additionally, there was a 43 percent decrease in the number of children who had to limit physical activity and a 41 percent reduction in reports of missed school days. For their parents, that translated into a 50 percent drop in the time they had to miss work to care for ailing youngsters, the study found.

The results are so promising that Massachusetts Medicaid officials are working with the Children’s Hospital team to develop a similar plan to improve care and reduce costs statewide for children covered by the health insurance program for low-income residents. Asthma rates are disproportionately higher in poor neighborhoods.

The researchers compared the participants’ medical costs with those of asthmatic children from four similar, nearby communities who were not in the program. The program cost $2,529 per child, but because of fewer ER visits and hospital admissions, medical spending per child was $3,827 less than for children in the other communities over two years of follow-up. That translates to a $1.46 savings for every $1 spent.

“It’s very gratifying to see improved health outcomes for children and for families and also to be able to demonstrate cost savings,’’ said the study’s lead author, Dr. Elizabeth R. Woods, associate chief of adolescent/young adult medicine at Children’s.

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Woods said her team was surprised at the extent of environmental issues they found in homes.

“Most didn’t have vacuums and couldn’t afford them,’’ Woods said. “We didn’t expect to be supplying vacuums originally, but it really makes a big difference because any vacuum helps, but especially ones that have HEPA filters,’’ which capture more dust particles.

Woods’s team has expanded the program to more Boston neighborhoods since launching the study in October 2005, and has continued to find similar problems and results, right down to the lack of vacuum cleaners.

That was the case for Chanese Brown, a Mattapan single mother of two children, including an 11-year-old who has struggled with severe asthma attacks.

Before enrolling in the study in late 2009, the child, Thomas, was hospitalized at least once a month for asthma complications, including several times in intensive-care units, Brown said.

The asthma medications he took daily didn’t seem to help.

“They changed his medicines often because they couldn’t figure out what was going on,’’ Brown said. “He would be perfectly fine with no problems and maybe it would be a cloudy sky or something and instantly he’d have to be hospitalized.’’

Then the community worker from Children’s started visiting the home and found some likely culprits: brooms, feather dusters, and scented cleaning products, for starters.

The community worker, Massiel Ortiz, who also has asthma, became a teacher, trusted friend, and shoulder for Brown to cry on when she became overwhelmed by Thomas’s hospitalizations.

Last year Thomas was not hospitalized once, Brown said, although he did go to the emergency room a couple of times. But he also was well enough to join basketball and tennis teams for the first time and go on his first out-of-state school field trip.

Dr. Julian Harris, Massachusetts Medicaid director, said the community health workers are key because they often struggle with the same diseases and can share insights about how to battle hurdles for treatment.

“They can often help patients to communicate more effectively with their health care providers and navigate the medical system,’’ Harris said.

His agency is working with Children’s to develop a three-year, $600,000 pilot program, subject to federal approval, that would enroll between 100 and 200 severely asthmatic children.

Harris said health-care providers in the pilot would get a predetermined amount per child use for home visits by health-care workers, nurses coordinating the care, and supplies to help improve home environments.

State Representative Jeffrey Sanchez, a Jamaica Plain Democrat, successfully lobbied to include language in the state budget that directs Medicaid to create the pilot program. Sanchez has said that asthma was so much a part of his life growing up in Boston public housing that it seemed as if all of his friends had it.

Doug Brugge, a Tufts University School of Medicine professor who researches asthma in Boston’s neighborhoods, said the Children’s study, with its use of community health workers, seems a sound “very real-life, real-world approach’’ to attacking asthma.

But he said specialists should be cautious about its dramatic findings because the study did not select children randomly - a gold standard in research - but instead chose specific patients. He said findings from other studies, however, suggest that the Children’s results are reasonable.

“I think it’s highly plausible that they did have the effects they hope they did,’’ he said, “but you have to stop a little short of considering it as proof.’’

Kay Lazar can be reached at klazar@globe.com.

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