Title: Reducing Asthma Disparities (RAD)
Organization: Baltimore City Health Department
Innovation Type: Community Based Chronic Disease Management
What we’re doing:
Providing an evidence-based 6-session home
visiting program for persistent asthmatic children in Baltimore to reduce home environmental asthma
triggers and increase medication adherence.
The Reducing Asthma Disparities (RAD) Program targeted over 200 Baltimore school aged persistent
asthmatics, identified by school nurses, health care providers and emergency
departments for home based, individualized assessments and interventions. The CDC-funded program was modeled on the successful
Seattle King County Asthma Program[i] and included six Baltimore specific adaptations. After an initial interview and room-by-room asthma
trigger assessment of the family’s home, staff and caregivers developed an
individualized plan to reduce/eliminate home asthma triggers and to improve the
child’s adherence to asthma medication and medical follow-up. Information from observations and
individualized plans were faxed to the child’s primary care provider following
every visit. The program provided families
with bedding and pillow covers, cleaning supplies, and a vacuum cleaner. Staff worked with providers to ensure that
each child had an Asthma Action Plan, appropriate medication (controller and
rescue) at home and school, and knew how to properly administer the medication.
The program included six home visits in a one year period, ending with another
interview and room-by-room assessment of the home at one-year.
Evaluation Type: Quasi-experimental
Compare initial and one year medical histories, visual assessments, and Emergency
Department and hospitalization costs.
For 102 children who completed the program there were statistically
significant (p=0.0001) decreases in asthma symptoms and Emergency Department
days with asthma symptoms in past 14 days - ↓
nights with asthma symptoms in past 14 days - ↓
days had to stop usual activity in past 14 days
- ↓ 2.0 days
days using rescue medication in past 14 days - ↓
ED visits in past year - ↓ 1.0 visit
There was also an increase in use of controller
medication by 1.3 days in the past 2 weeks but it was not statically
There was a
significant decrease in the number of hospitalizations (p=0.02).
Potential for cost savings
Using average Maryland Medicaid costs for
hospitalizations and ED visits (2011), and comparing the costs for one year
prior to enrollment to one year post enrollment for 102 children with the costs
asthma home visiting program, we estimate:
Costs averted (hospitalizations & ED visits) = $172,364 ($1,690/child)
Home visiting program costs = $141,372 ($1,386/child)
Potential cost-savings for third-party payers = $30,992 ($304/child)
These results are consistent with other studies showing the
cost effectiveness of asthma home visiting programs [2,3]. Krieger et al (2005)1 in a
randomized clinical trial reported program costs of $1,316 per participant and
direct medical costs averted were $124-$147 per participant. In the RAD program
outcome measures are based on patient reports rather than medical records. We will investigate outcomes for program
participants and a selection of matched controls using Medicaid claims data later
RAD enrollment closed in 2011. Additional resources are needed to provide
effective home-based, multi-trigger, multi-component interventions, such as
this home-visiting program, to communities with high childhood asthma burdens [4, 5]. Securing funding for asthma home visiting
services in Maryland would be a good first
step in ensuring adequate community resources to address health disparities in
childhood asthma for Maryland’s
children.[vi] The RAD program might be a good fit for
patient-centered medical homes, particularly those serving large populations of
children with asthma.
Population Served: Baltimore City
public school children, aged 4-18 (95% African American, 63% male, average age
at enrollment 8.7 years). Average family
size 4.4 persons (SD = 1.5), with an average of 2 persons with asthma (SD =
Implementation: 2009 - 2012
Contact: Kate Scott, Asthma Program Director,
Baltimore City Health Department email@example.com
 Krieger JW, Takaro TK, Song L, Weaver M. The
Seattle–King County Healthy Homes Project: a randomized, controlled trial of a
community health worker intervention
to decrease exposure to indoor asthma triggers. Am J Public Health 2005;
 Crocker DD, Kinyota S, Dumitru GG, et al. Effectiveness of
home-based, multi-trigger, multicomponent interventions with an environmental
focus for reducing asthma morbidity: a Community Guide systematic review. Am J
Prev Med 2011;41(2S1): S5–S32.
 Nurmagambetov TA, Barnett SBL, Jacob V, et al.
Economic value of home-based, multi-trigger, multicomponent interventions with
an environmental focus for reducing asthma morbidity: a Community Guide
systematic review. Am J Prev Med 2011;41(2S1):S33–S47.
 Task Force on Community Preventive Services. Recommendations
from the Task Force on Community Preventive Services to decrease asthma
morbidity through home-based, multi-trigger, multicomponent interventions. Am
J Prev Med 2011;41(2S1):S1–S4.
 Krieger J. Home visits for asthma: we cannot afford to
wait any longer. Arch Pediatr Adolesc Med 2009;163(3):279–81.
 Krieger JW, Philby ML, Brooks, MZ. Better home visits for asthma; lessons
learned from the Seattle-King County Asthma Program. Am J Prev Med