School-Based Asthma Therapy

An Evidence-Based Practice

Description

Funded by a grant from the National Heart, Lung, and Blood Institute, this school-based intervention sought to improve the health of urban children with asthma by administering their medication in the school setting. Children with physician-diagnosed asthma, ages 3 to 10, were recruited through elementary and preschools in the Rochester City School District. Participants were stratified by exposure to tobacco smoke at home and then randomized to either usual care or administration of one dose of preventive asthma medication at school by the school nurse each school day. Parents were responsible for medication administration on weekends and other days the child did not attend school. Children were followed for one school year (7-9 months). All families were given diaries to track their child's symptoms and health outcomes were assessed by monthly telephone interviews. The primary outcome was the mean number of symptom-free days (SFD).

To evaluate cost-effectiveness, programmatic costs (total staff salaries divided by the number of children), health care costs, school attendance fees losses, and parents' productivity losses were considered.

Goal / Mission

The objective of this study was to examine the health benefits and cost-effectiveness of the School-Based Asthma Therapy (SBAT) program compared with usual care.

Impact

School-Based Asthma Therapy resulted in 158 symptom-free days per month per 100 children and a cost-effectiveness of $10 per symptom-free day.

Results / Accomplishments

The health benefit of the School-based Asthma Therapy program was equal to approximately 158 SFDs gained per 30-day period (p<0.05) per 100 children. Children receiving medication through school had significantly more symptom-free days during the peak winter season than the control group children (p<0.001). In addition, the intervention group had fewer symptoms at night, less use of rescue medication, fewer days with limited activity (p<0.01 for all) and lower risk for an exacerbation requiring prednisone (p=0.05). Even for those children who were exposed to smoke at home, the intervention showed positive effects on mean symptom-free days per two weeks.

The programmatic expenses of the the intervention summed to an extra $4822 per month per 100 children. The net savings due to the intervention (reduction in medical costs and parental productivity losses, and improvement in school attendance) was $3240 per month per 100 children, resulting in incremental cost-saving difference of $1583 per month per 100 children and cost-effectiveness of $10 per 1 extra SFD gained.

About this Promising Practice

Organization(s)
University of Rochester School of Medicine and Dentistry, Department of Pediatrics
Primary Contact
Katia Noyes, PhD, MPH
University of Rochester Medical Center
School of Medicine and Dentistry
601 Elmwood Ave, Box SURG
Rochester, NY 14642
(585) 275-8467
katia_noyes@urmc.rochester.edu
https://www.urmc.rochester.edu/people/21761294-eka...
Topics
Health / Respiratory Diseases
Health / Children's Health
Health / Health Care Access & Quality
Organization(s)
University of Rochester School of Medicine and Dentistry, Department of Pediatrics
Source
American Academy of Pediatrics
Date of publication
2/11/2013
Date of implementation
2006
Geographic Type
Urban
Location
Rochester, NY
For more details
http://pediatrics.aappublications.org/content/earl...
http://archpedi.jamanetwork.com/article.aspx?artic...
Target Audience
Children, Families

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Related Content for: School-Based Asthma Therapy

An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.