In-home program improves outcomes, saves money
Program saved $4,500 per patient per year
In-home education of children with asthma and their families may be labor-intensive, but it has produced a dramatic improvement in outcomes for patients and saved providers an average of more than $4,500 in medical costs per patient this year in the experience of one major home health care agency.
Olsten Health Services found great success with a program using registered nurses who were specifically trained to assess the needs of a wide range of pediatric asthma patients and teach them how to manage their disease. Olsten is a large Melville, NY-based provider of home health services with about 400 offices in nearly every state.
The company has provided multipart individualized education for 884 children with asthma and their families since 1995. Since late 1996, 462 adults with asthma have participated in similar training.
An average of 5.5 hours of self-management training resulted in a 43% decrease in the number of hospitalizations and a decrease in the numbers of days spent in the hospital by more than half, from 3 to 1.45.
There were also 56% fewer doctor office visits within three months after the kids completed Olsten’s program, compared to their pre-educational intervention rate.
In addition, Olsten reports the children gained substantial control of their asthma as a result of the program. Results for the first four months of 1999 show 14 children were classified as "severe" by the RNs who assess each child, but only 5 still had that classification after participating three months. There were 52 patients classified as moderate when they began the program, but after three months, only 32 still had the moderate rating.
The largest shift was in the "mild" classification. Before the program, there were 34 patients in this group. At the end, the group contained 62 patients, indicating large numbers of patients who improved enough to be classified in a less-serious stage of the disease.
In the early years of the program, the results were even more dramatic and the savings were substantially more, "because we were getting the worst of the worst cases," explains David Schlumper, MS, Olsten’s project manager in Natick, MA.
Olsten reported a savings of $11,500 per patient in the first year of the program (1995), and by 1997, reported a savings of $11,868.99 per patient per year.
The figure has dropped this year, Schlumper says, because the self-management program is expanding as physicians and clinics become more aware of the program and its potential to improve outcomes and alleviate the severity of young patients.
"We’re getting them earlier now, before they get to be in such serious condition," he says.
"We think that people learn better in the comfort of their own home," says Mary Weber, RN, Olsten’s director of clinical development based in Indianapolis. "And we get a chance to assess the environmental triggers in the home."
All Olsten’s in-home educators are registered nurses who have received at least eight hours of training in asthma management and are well-prepared to design individualized education modules depending on the patient’s age, the family situation and even the involvement of siblings.
Olsten began the program in 1995 with seven weekly one-hour sessions, but Weber says the agency quickly learned effective results could be produced in 5.5 hours for a price to the provider, whether it is a private or public payer, for about the cost of one emergency department visit.
The program is geared toward what Weber calls "metamemory," the premise under which children learn best when large amounts of new information (such as the use of medications and inhalers) are taught in small pieces over repeated sessions.
Schlumper adds that young children learned very well with the help of rhymes. A favorite: "Relax. Early to bed. Maybe a med."
Games, videos, stories, coloring books, and flash cards are all used. "Everyone learns in a different way, so our educators are trained to find the way that works best," Weber says.
A favorite game for toddlers is the air molecule game. "We get all the family members to stand with their legs apart, and have the child crawl through, just like an air molecule would move easily through the airways," says Weber. "Then we show them what happens when the airways become inflamed and start to close off by having the adults and older kids close their legs, making it harder for the air molecule to get through. Finally, we show them what happens when they take their meds and the airway opens up again."
The key: It’s fun, and the kids remember it, says Weber. And the children were able to retain the information fairly well eight months after they completed the program, Weber says.
Immediately after the end of the program, 93% of the participants could name asthma triggers. Eight months later, 91% still could name them. At the end of their program, 85% could name the steps to avoid an asthma episode, and eight months later, 77% still could.
Why do this type of education at home rather than in a clinic setting? "Because people are much more relaxed and open at home. It’s not related to a traumatic event, like it would be if they were in a hospital classroom," Weber says.
In-home education like Olsten’s can be an important component of a program to help patients better manage their disease, says Jean Hanson, PhD, RN, former manager of the pediatric pulmonary center at the University of New Mexico in Albuquerque and now at the university’s continuing education nursing division.
A couple of years ago, Hanson wrote about a unique program, which recruited and paid parents of asthmatic children as part-time teachers of in-home modules for parents of newly diagnosed children with asthma.
"We didn’t find any really dramatic improvements, especially not in helping boost their confidence in their abilities to prevent episodes," Hanson says, "But now I think full-time educators might work out better."
She says the key lies not necessarily in the use of registered nurses, but in the use of full-time trained personnel "who can relate well to patients and their families."
Olsten also offers an in-home adult asthma management program that has had similar results in improving outcomes and cutting costs.
[David Schlumper can be reached at (800) 925-9911 and Mary Weber at (317) 283-1882.]
In-Home Program Components
The following are components of the in-home asthma management program of Melville, NY-based Olsten Health Services:
Baseline physical assessmentAnatomy and physiology of asthma
Peak flow meters
When to call the doctor
Early warning signs of asthma
Identifying triggers
The world around us
Environmental home walk-through
Asthma medications
Proper use of asthma-related devices
Good health practices
Communication with health professionals
Strategies for living with asthma
Situational problem-solving
Emergency management
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