MCO USE OF A PEDIATRIC ASTHMA MANAGEMENT PROGRAM

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Asthma is a chronic, inflammatory disease of the airways with increasing morbidity and mortality. Despite the availability of treatment guidelines, primary care providers continue to under- use anti-inflammatory therapy. Easy Breathing is an asthma management program for inner city children in Hartford, CT. Easy Breathing is based upon the NHLBI: NAEPP guidelines and utilizes a validated survey instrument, a standardized treatment menu based upon asthma severity and NHLBI asthma guidelines and a standardized treatment plan. Adherence to guidelines for primary care providers in Easy Breathing, based upon prescribing data, is 94 percent. It is not known, however, whether the results obtained in Easy Breathing are reproducible in other communities and in other settings. The goals of this project are: 1. To determine the reproducibility of Easy Breathing when the program is implemented in an insured, private practice, urban/suburban setting; 2. To determine whether partnering with a managed care organization (MCO) to disseminate and implement Easy Breathing is an effective strategy that is capable of being self-sustained; 3. To study the effectiveness of adherence to guidelines by primary care providers in a private practice setting on hospitalization rates, emergency room visits, prescription utilization, patient/family satisfaction and quality of life and provider satisfaction; and 4. To calculate the cost burden of asthma and the effect of Easy Breathing in an MCO on that burden. In a randomized study, Easy Breathing II will be implemented in 18 communities in the Hartford area, with 66 providers who care for 14,756 children who are managed by a single MCO. Control sites will be offered Easy Breathing II during the second year. Outcome measures will include: adherence to guidelines, anti-inflammatory prescription rates and utilization rates, rates of hospitalization and emergency room visits, patient/family/provider satisfaction and patient/caregiver adaptive perceptions and quality of life. Additionally, the cost to the MCO to manage asthma, the total medical costs of the population with asthma before and after implementing Easy Breathing and the cost of Easy Breathing will be calculated. It is anticipated that Easy Breathing will result in improved adherence to guidelines, decreased medical costs and enhanced satisfaction by providers, patients, and caregivers.