The Child Asthma Link Line: A Coalition-initiated, Telephone-based, Care Coordination Intervention for Childhood Asthma

Abstract

Background. Childhood asthma is a complex chronic disease that poses significant challenges regarding management, and there is evidence of disparities in care. Many medical, psychosocial, and health system factors contribute to recognized poor control of this most prevalent illness among children, with resultant excessive use of emergency departments and hospitalizations for care. Recent national guidelines emphasize the need for community-based initiatives to address these critical issues. To address health system fragmentation and impact asthma outcomes, the Philadelphia Allies Against Asthma coalition developed and implemented the Child Asthma Link Line, a telephone-based care coordination and system integration program, which has been in operation since 2001. This study evaluates the effectiveness of the Child Asthma Link Line integration model to improve asthma management by measuring utilization markers of morbidity. Methods. Medicaid Managed Care Organization claims data for 59 children who received the Link Line intervention in 2003 are compared to a matched sample of 236 children who did not receive the Link Line intervention. Children in the two study groups are ages 3 through 12 years and matched on 2003 emergency department visits, age, gender, and race/ethnicity. Primary outcome variables analyzed in this study are emergency department visits, hospitalizations, and office visit claims from the follow-up year (2004). Results. Link Line intervention children were significantly less likely to have follow-up hospitalizations than matched sample children (p = .02). Children enrolled in the Link Line were also more likely to attend outpatient office visits in the follow-up year (p = .045). In addition, Link Line children with multiple emergency department visits in 2003 were significantly less likely to have an emergency department visit in 2004 (p = .046). Conclusion. This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.

Keywords :

• care coordination
• childhood asthma
• chronic disease
• coalition
• community-based participatory research

Notes

1 Data on 3- and 4-year-old children were only available from one MMCO.

2 Children were matched on the number of Emergency Department visits in addition to standard demographics because a large number were referred from the ED and matching on ED visits is also a proxy for a control for severity of asthma.

3 Most Link Line children who did not have an exact match on the number of 2003 ED visits were matched with someone of the same age, gender, and number of ED visits who had one more or one fewer 2003 ED visit, rotating from one-fewer to one-more ED visit. However, for two extreme cases (six and seven ED visits), a near match was not possible; these children were matched with a child who had the same demographic make-up, but between two and five ED visits during the baseline year (2003). The slight differences in the distribution of race/ethnicity are the result of four Link Line cases for which there were no exact matches. Two comparison cases had undetermined race/ethnicity; thus, two randomly selected Black children (the majority race/ethnicity) with the same age, gender, and number of ED visits were matched with these two cases. One White female child had only one exact match; thus, one Black, one Hispanic, and one “other” female child of the same age and number of ED visits were designated as the three other matches for this child. Finally, for one Black child, only three Black children of the same age, gender, and number of ED visits were available in the data set. This child was matched with another child for whom race was missing.