Successful school-based intervention for inner-city children with persistent asthma

Abstract

Objective: Because children attend school daily, school-based interventions for children with persistent asthma could provide effective disease management for inner-city asthmatic children. The Kunsberg School in Denver, Colorado, enrolls children with chronic diseases, including asthma, into a daily program of school-based disease management. This study sought to determine the impact of the Kunsberg program on asthma utilization.

Methods: Children attending Kunsberg (n=18) who received primary care at Denver Health were compared with a group of matched control children who also received primary care at Denver Health, but did not attend Kunsberg (n=36). Asthma-related utilization for an average of 2.9 years before and after Kunsberg enrollment was assessed.

Results: The 18 Kunsberg and 36 control subjects were mostly minority children in low-income families, without significant demographic differences between groups. Compared with controls, the Kunsberg cohort experienced fewer hospitalizations (0.5 vs. 0.9 hospitalizations/subject/ year, p=0.05), fewer emergency department (ED) visits (1.4 vs. 2.8 ED visits/ subject/year, p=0.04), and fewer follow-up visits for asthma (3.7 vs. 5.0 visits/subject/ year, p=0.01) in the time period (mean 2.9 years; range 1-6 years) following the intervention. Hospital- and clinic-based asthma utilization costs decreased 80% following enrollment in the school (8122 dollars/year to 1588 dollars/year per child), compared to a 19% decrease in the control group. Among the Kunsberg children with hospitalizations prior to school enrollment (n=8), hospital days decreased from 3.5 days to 0.1 days annually (p<0.01), ED visits decreased from 2.1 to 0.6 visits annually (p=0.02), and follow-up visits decreased from 6.8 to 2.1 visits annually (p=0.02). As part of their school program, 89% of Kunsberg enrollees received inhaled corticosteroids daily on a monitored basis while at school.

Conclusions: The Kunsberg school program improved asthma control and reduced disease severity for at-risk inner-city asthmatic children, leading to cost reduction for asthma management. Directly observed controller therapy at school can be an important component of a school-based program for children with chronic conditions.