The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project

Abstract

Background: A substantial proportion of low-income children with asthma living in rural western North Carolina have suboptimal asthma management. To address the needs of these underserved children, we developed and implemented the Regional Asthma Disease Management Program (RADMP); RADMP was selected as one of 13 demonstration projects for the National Asthma Control Initiative (NACI). Methods: This observational intervention was conducted from 2009 to 2011 in 20 rural counties and the Eastern Band Cherokee Indian Reservation in western North Carolina. Community and individual intervention components included asthma education in-services and environmental assessments/remediation. The individual intervention also included clinical assessment and management. Results: Environmental remediation was conducted in 13 childcare facilities and 50 homes; over 259 administrative staff received asthma education. Fifty children with mild to severe persistent asthma were followed for up to 2 years; 76% were enrolled in Medicaid. From 12-month pre-intervention to 12-month post-intervention, the total number of asthma-related emergency department (ED) visits decreased from 158 to 4 and hospital admissions from 62 to 1 (p < 0.0001). From baseline to intervention completion, lung function FVC, FEV1, FEF 25–75 increased by 7.2%, 13.2% and 21.1%, respectively (all p < 0.001), and average school absences dropped from 17 to 8.8 days. Healthcare cost avoided 12 months post-intervention were approximately $882 021. Conclusion: The RADMP program resulted in decreased ED visits, hospitalizations, school absences and improved lung function and eNO. This was the first NACI demonstration project to show substantial improvements in healthcare utilization and clinical outcomes among rural asthmatic children.

• Education
• management/control
• morbidity and mortality
• pediatrics
• treatment

Acknowledgements

Key collaborators include the North Carolina Asthma Program, Asthma Alliance of North Carolina, Western North Carolina School Systems and Child Care Centers, North Carolina Department of Health and Human Services, North Carolina Department of Environmental and Natural Resources-Children’s Environmental Health Branch, National Center for Healthy Housing, National Asthma Control Initiative (NACI) of the National Heart, Lung and Blood Institute of the National Institutes of Health, National Asthma and Allergy Foundation of America, WNC Primary Care Providers, Cherokee Indian Hospital Authority, Satellite Clinics, Sub-specialists, school nurses, social workers, and case managers.

Declaration of interest

There were no conflicts of interests for the authors. The National Asthma Control Initiative (NACI) was funded by the National Asthma Education and Prevention Program of the NHLBI. This project was supported, in part, by NIH contract number HHSN268200800317U. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI, NIH or DHHS.

Supplementary material available online

Supplementary Tables 1-3.