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Hatoun J, Barrieau DJ, Bryson EA, Bhaumik U, Woods ER. Primary care provider perceptions of an asthma home visiting program. J Asthma 2023; 60:1967-1972. [PMID: 37093899 DOI: 10.1080/02770903.2023.2206899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Pediatric asthma home visiting programs have improved clinical outcomes, but little is known about how providers perceive these programs. The purpose of this study was to understand how primary care providers and their colleagues in a medical home perceive an asthma home visiting program that is available at no cost to their patients. METHODS After several years of running an asthma home visiting program using community health workers (CHW) in 10 pediatric primary care offices in the South Coast of Massachusetts, we surveyed the providers of patients who had enrolled in the program. An anonymous online survey was developed by the program leaders, the program analytics team, and the CHWs for quality improvement purposes. Survey domains included the perceived utility of various aspects of the program, impact on patients, and interaction with CHWs, as well as demographic information about the providers. RESULTS Of the 24 providers asked to complete the survey from eight primary care practices, 21 completed the survey (88%). Respondents perceived that the most beneficial aspects were environmental assessment (95%), asthma education (91%), and addressing environmental issues (86%). In addition to numerous positive free-text responses, suggestions for improvement were in the areas of referral completion, post-visit communication, and patient identification in the medical record. All respondents would continue to refer to the program. CONCLUSIONS Primary care providers and medical home staff perceived an asthma home visiting program to have high utility, particularly the environmental assessment, asthma education, and mitigation of environmental issues. Additional opportunities for improvement were identified.
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Affiliation(s)
- Jonathan Hatoun
- Pediatric Physicians' Organization at Children's, Wellesley, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Daniel J Barrieau
- Pediatric Physicians' Organization at Children's, Wellesley, MA, USA
| | - Emily A Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Office of Community Health, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Woods
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Fee C, Fuller J, Guss CE, Woods ER, Cooper ER, Bhaumik U, Graham D, Burchett S, Dumont O, Marty E, Narvaez M, Haberer JE, Swendeman D, Mulvaney SA, Kumar VS, Jackson JL, Ho YX. A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study (Preprint). JMIR Form Res 2022; 6:e39357. [DOI: 10.2196/39357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/24/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
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Woods ER, Sommer SJ, Bryson EA, Shreeve KM, Graham D, Nethersole S, Bhaumik U. Improved 10-year cost savings for patients served by the Boston Children's Hospital Community Asthma Initiative. J Asthma 2021; 59:2258-2266. [PMID: 34904928 DOI: 10.1080/02770903.2021.2010746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide a 10-year follow-up of asthma cost-savings for patients served by the Community Asthma Initiative (CAI) group compared to a coarsely cost-matched comparison group from similar neighborhoods (comparison group). METHODS CAI provided home visits and case management services for patients identified through emergency department (ED) visits and hospitalizations. Asthma costs for the two groups were extracted from the hospital administrative database for ED visits and hospitalizations for one year before and 10 years of follow-up. To eliminate cost differences at intake, a coarse cost-matching was implemented by randomly selecting comparison patients with similar costs to CAI patients (N = 208 pairs). The difference in cost-reduction between CAI and comparison patients was used to compute the adjusted Return on Investment (aROI). RESULTS There were no significant differences between CAI and comparison groups, including baseline age (5.9 years [SD 2.9] v. 4.4 [SD 3.1]); Hispanic (46.2% v. 35.1%) and Black (43.9% v. 53.0%) race/ethnicity; and public insurance (71.2% v. 68.8%). The cost reduction difference for CAI was significant at one year (P = 0.0001) and two years (P = 0.03), but did not reach the level of significance for years 3-10. The CAI group had a greater cumulative cost reduction of $5,321 (P = 0.08, not significant). Average program cost per patient was $2,636. CAI broke-even after 3 years (aROI = 1.04) and yielded an adjusted ROI of 1.99 at 10 years. CONCLUSIONS The greater reduction in cumulative cost for CAI patients suggested a shift in trajectory at 10 years of follow-up, resulting in a positive aROI after three years.
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Affiliation(s)
- Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan J Sommer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Emily A Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kyra M Shreeve
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Harvard Medical School, Boston, MA, USA.,Program for Patient Quality and Safety, Boston Children's Hospital, Boston, MA, USA
| | - Shari Nethersole
- Harvard Medical School, Boston, MA, USA.,Office of Community Health, Boston Children's Hospital, Boston, MA, USA
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Office of Community Health, Boston Children's Hospital, Boston, MA, USA
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Bhaumik U, Subramaniyam V, Kandukuru R. Post-traumatic stress, anxiety and depression after intensive care unit stay: Findings from a general hospital. Eur Psychiatry 2021. [PMCID: PMC9471621 DOI: 10.1192/j.eurpsy.2021.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPost-traumatic stress disorder (PTSD) following intensive care is a relatively new entity. It is triggered due to traumatic experiences in a setting of threat to life due to illness. Prolonged stay in intensive care predisposes to delusional memories related to the stay experience and may increase likelihood of post-traumatic stress.It may also present as anxiety or depression.ObjectivesThis study explored the prevalence of post-traumatic symptoms in intensive care, find its correlates and its impact on health-related quality of life (HRQoL).Methods225 adult patients admitted for at least 1 day in the intensive care unit (ICU) of a general hospital in Bangalore,India were recruited and assessed at 1 week,1 month and 3 months after ICU discharge. Subjects were assessed for ICU related memories, PTSD, anxiety and depression scores and quality of life at and post discharge.Results59.6% of the study population had significant post-traumatic stress, including anxiety in 62.35%, depression in 10.58% and mixed anxiety-depression in 27.06%. Delusional memories were found in 31.6%. Presence of delusional memories was found to have significant correlation with post-traumatic stress and had a negative impact on HRQoL.ConclusionsThis study was the first of its kind from Asia. More systematic studies on PTSD following ICU stay and its correlates are required as available evidence lacks homogeneity. Suitable preventive measures should be taken to reduce prevalence of post-traumatic stress in intensive care due to its lasting impact on HRQoL.DisclosureNo significant relationships.
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Shreeve K, Woods ER, Sommer SJ, Lorenzi M, Monteiro K, Nethersole S, Bhaumik U. Community Health Workers in Home Visits and Asthma Outcomes. Pediatrics 2021; 147:peds.2020-011817. [PMID: 33766919 DOI: 10.1542/peds.2020-011817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Community Asthma Initiative (CAI) was included in the New England Asthma Innovations Collaborative, which received a Centers for Medicare and Medicaid Services (CMS) Innovation grant. Under this grant, CAI transitioned from a mixed community health worker and nurse model to a nurse-supervised community health worker model. CMS limited enrollment to patients with Medicaid and encouraged 3 home visits per family. METHODS A total of 389 patients enrolled under the CMS grant at Boston Children's Hospital from 2013 to 2015 (CMS group) were compared with 733 CAI patients with Medicaid enrolled from 2005 to 2012 (comparison group). Changes in 5 asthma-related measures (emergency department visits, hospitalizations, physical activity limitations, missed school days, and parent and/or guardian missed workdays) were compared between baseline and 6 and 12 months postenrollment. Measures were analyzed as dichotomous variables using logistic regression. Numbers of occurrences were analyzed as continuous variables. Changes in quality of life (QoL) among the CMS group were examined through a 13-question survey with activity and emotional health subscales. RESULTS Although patients in both groups exhibited improvement in all measures, the CMS group had greater odds of decreased hospitalizations (odds ratio 3.13 [95% confidence interval 1.49-6.59]), missed school days (1.91 [1.09-3.36]), and parent and/or guardian missed workdays (2.72 [1.15-6.41]) compared to the comparison group. Twelve months postenrollment, the CMS group experienced improvement in all QoL questions and subscales (all P values <.01). CONCLUSIONS The CMS group showed improved outcomes for hospitalizations and missed school and workdays compared to the comparison group. The CMS group also exhibited significant improvement in QoL.
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Affiliation(s)
| | | | | | | | | | - Shari Nethersole
- Office of Community Health, Boston Children's Hospital, Boston, Massachusetts
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine and.,Office of Community Health, Boston Children's Hospital, Boston, Massachusetts
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Abstract
Introduction Cyberchondria is a pathological behaviour linked to excessive online searching of health information.It is frequently associated with health anxiety. It may be regarded as an compulsive behaviour secondary to obsessions about a real or an imagined illness. The coronavirus pandemic of 2019 has brought about a fear of getting infected. In the absence of a definitive cure, the focus largely lies on stringent preventive measures and early diagnosis. Known to present with diverse symptoms, fear of coronaviral infection makes affected individuals search for symptoms on internet for reassurance. Added misinformation further increases stress,anxiety and confusion. Objectives The authors attempt to describe cyberchondria and highlight its increased prevalence during the coronavirus pandemic. Methods 5 cases from different backgrounds were seen in the outpatient clinic during the months of April-July 2020.Consent was obtained from subjects before the study.They were clinically diagnosed with obsessive-compulsive disorder and exhibited cyberchondria in the background of the pandemic. Results All of the described 5 cases had prominent fear of contracting or having contracted coronavirus disease-19.All of them were found to have significant scores rang on Yale-Brown Obsessive-Compulsive Severity Scale(ranging from 25-35) and improved after a trial of selective serotonin reuptake inhibitors. Conclusions The emergence of cyberchondria during the coronavirus -19 pandemic warrants further introspection.Changes in policy-making to prevent misinformation and present health information in a simple way to prevent confusion in the lay public is a necessity to tackle this problem in the near future.
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Bhaumik U, Sommer SJ, Lockridge R, Penzias R, Nethersole S, Woods ER. Community Asthma Initiative: Cost Analyses using Claims Data from a Medicaid Managed Care Organization. J Asthma 2019; 57:286-294. [PMID: 30663906 DOI: 10.1080/02770903.2019.1565825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Use claims data to examine the cost benefit of the Community Asthma Initiative (CAI), a Boston area nurse-supervised community health worker (CHW) asthma home-visiting program. Methods: The reduction in asthma treatment costs was assessed using Massachusetts claims data from one Medicaid Managed Care Organization (MCO) in the north east that included all costs between January 1, 2011 and December 31, 2016. The data was used to determine asthma-related utilization cost reductions between 1 year pre- and 1, 2 and 3 years post-intervention. The cost reductions for 45 CAI patients and 45 cost-matched comparison patients were measured. Return on investment (ROI) was computed as the difference in cost reduction for CAI patients and a cost-matched comparison population divided by CAI program cost. Results: The excess reduction in per patient asthma-related utilization costs among CAI patients compared to the comparison population was $806 (p = 0.047), $1,253 (p = 0.01) and $1,549 (p = 0.005) between 1 year pre- and 1, 2 and 3 years post-intervention. These yielded adjusted ROI's of 0.31, 0.78 and 1.37 after 1, 2 and 3 years post-CAI intervention. Conclusions: The reduction in asthma utilization costs of a home visit program by nurse-supervised CHWs exceeds program costs. The findings support the business case for the provision of secondary prevention of home-based asthma services through reimbursement from payers or integration into Accountable Care Organizations (ACOs).
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Affiliation(s)
- Urmi Bhaumik
- Office of Community Health, Boston Children's Hospital, Boston, MA, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Susan J Sommer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Ryan Lockridge
- Neighborhood Health Plan, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca Penzias
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Shari Nethersole
- Office of Community Health, Boston Children's Hospital, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Penzias RE, Sanabia V, Bhaumik U, Sommer SJ, Shreeve KM, Woods ER. Parent experiences with a nurse-supervised community health worker asthma home-visiting program. J Asthma 2018; 56:1314-1324. [PMID: 30395749 DOI: 10.1080/02770903.2018.1536144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: This study seeks to identify helpful components of a nurse-supervised Community Health Worker (CHW) asthma home-visiting program, obtain feedback from parents and families about their experiences, and receive suggestions for new services that the program could provide. Methods: Likert scale ratings and semi-structured qualitative interviews were conducted with parents who were selected from a representative sample and previously participated in the program. Five-point Likert scale ratings from 1 (not helpful) to 5 (very helpful) were obtained for 11 program components. Interviews were analyzed using a grounded theory participatory approach. Data were analyzed and themes were identified by two different coders using Dedoose software. Results: A total of 22 participants were enrolled and 20 participants completed Likert scale ratings and qualitative interviews. Likert scale ratings (mean standard deviation [SD]) show that program strengths include asthma education (4.75 [0.55]), supplies (4.65 [0.99]), help with housing conditions (3.94 [1.56], pest management (3.79 [1.69]) and greater access to community resources (3.70 [1.30]). The ratings suggest that families need more help with other social determinants of health, such as school, lack of enough money or food, and mental health and behavioral concerns (3.05 [1.78]). Interviews echoed these ratings and revealed several themes about family and parental stress, children's activity limitations, desire for outreach after the 12-month intervention, a need for help with other social determinants and more emotional support. Conclusions: This study shows that the program was well received and reveals the importance of addressing social determinants of health and behavioral health concerns.
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Affiliation(s)
- Rebecca E Penzias
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Virginia Sanabia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA.,Office of Community Health, Boston Children's Hospital , Boston , MA , USA
| | - Susan J Sommer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Kyra M Shreeve
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
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Dong Z, Nath A, Guo J, Bhaumik U, Chin MY, Dong S, Marshall E, Murphy JS, Sandel MT, Sommer SJ, Ursprung WWS, Woods ER, Reid M, Adamkiewicz G. Evaluation of the Environmental Scoring System in Multiple Child Asthma Intervention Programs in Boston, Massachusetts. Am J Public Health 2017; 108:103-111. [PMID: 29161061 DOI: 10.2105/ajph.2017.304125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the applicability of the Environmental Scoring System, a quick and simple approach for quantitatively measuring environmental triggers collected during home visits, and to evaluate its contribution to improving asthma outcomes among various child asthma programs. METHODS We pooled and analyzed data from multiple child asthma programs in the Greater Boston Area, Massachusetts, collected in 2011 to 2016, to examine the association of environmental scores (ES) with measures of asthma outcomes and compare the results across programs. RESULTS Our analysis showed that demographics were important contributors to variability in asthma outcomes and total ES, and largely explained the differences among programs at baseline. Among all programs in general, we found that asthma outcomes were significantly improved and total ES significantly reduced over visits, with the total Asthma Control Test score negatively associated with total ES. CONCLUSIONS Our study demonstrated that the Environmental Scoring System is a useful tool for measuring home asthma triggers and can be applied regardless of program and survey designs, and that demographics of the target population may influence the improvement in asthma outcomes.
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Affiliation(s)
- Zhao Dong
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Anjali Nath
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Jing Guo
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Urmi Bhaumik
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - May Y Chin
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Sherry Dong
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Erica Marshall
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Johnna S Murphy
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Megan T Sandel
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Susan J Sommer
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - W W Sanouri Ursprung
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Elizabeth R Woods
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Margaret Reid
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Gary Adamkiewicz
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
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10
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Bhaumik U, Sommer SJ, Giller-Leinwohl J, Norris K, Tsopelas L, Nethersole S, Woods ER. Boston children's hospital community asthma initiative: Five-year cost analyses of a home visiting program. J Asthma 2016; 54:134-142. [PMID: 27624870 DOI: 10.1080/02770903.2016.1201837] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the costs and benefits of the Boston Children's Hospital Community Asthma Initiative (CAI) through reduction of Emergency Department (ED) visits and hospitalizations for the full pilot-phase program participants. METHODS A cost-benefit analyses was conducted using hospital administrative data to determine an adjusted Return on Investment (ROI): on all 268 patients enrolled in the CAI program during the 33-month pilot program phase of CAI intervention between October 1, 2005 and June 30, 2008 using a comparison group of 818 patients from a similar cohort in neighboring ZIP codes without CAI intervention. Cost data through June 30, 2013 were used to examine cost changes and calculate an adjusted ROI over a 5-year post-intervention period. RESULTS CAI patients had a cost reduction greater than the comparison group of $1,216 in Year 1 (P = 0.001), $1,320 in Year 2 (P < 0.001), $1,132 (P = 0.002) in Year 3, $1,123 (P = 0.004) in Year 4, and $997 (P = 0.022) in Year 5. Adjusting for the cost savings for the comparison group, the cost savings from the intervention resulted in an adjusted ROI of 1.91 over 5 years. CONCLUSIONS Community-based, multidisciplinary, coordinated disease management programs can decrease the incidence of costly hospitalizations and ED visits from asthma. An ROI of greater than one, as found in this cost analysis, supports the business case for the provision of community-based asthma services as part of patient-centered medical homes and Accountable Care Organizations.
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Affiliation(s)
- Urmi Bhaumik
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA.,b Office of Community Health, Boston Children's Hospital , Boston , MA , USA
| | - Susan J Sommer
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Judith Giller-Leinwohl
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Kerri Norris
- c Department of Finance , Boston Children's Hospital , Boston , MA , USA
| | - Lindsay Tsopelas
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Shari Nethersole
- b Office of Community Health, Boston Children's Hospital , Boston , MA , USA.,d Division of General Pediatrics, Boston Children's Hospital , Boston , MA , USA
| | - Elizabeth R Woods
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
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Lee LK, Mulvaney-Day N, Berger AM, Bhaumik U, Nguyen HT, Ward VL. The Patient Passport Program: An Intervention to Improve Patient-Provider Communication for Hospitalized Minority Children and Their Families. Acad Pediatr 2016; 16:460-467. [PMID: 26724179 DOI: 10.1016/j.acap.2015.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/23/2015] [Accepted: 12/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Effective patient-provider communication is essential to improve health care delivery and satisfaction and to minimize disparities in care for minorities. The objective of our study was to evaluate the impact of a patient-provider communication program, the Patient Passport Program, to improve communication and satisfaction for hospitalized minority children. METHODS This was a qualitative evaluation of a communication project for families with hospitalized children. Families were assigned to either the Patient Passport Program or to usual care. The Passport Program consisted of a personalized Passport book and additional medical rounds with medical providers. Semistructured interviews at the time of patient discharge were conducted with all participants to measure communication quality and patient/family satisfaction. Inductive qualitative methods were used to identify common themes. RESULTS Of the 40 children enrolled in the Passport Program, 60% were boys; the mean age was 9.7 years (range, 0.16-19 years). The most common themes in the qualitative analysis of the interviews were: 1) organization of medical care; 2) emotional expressions about the hospitalization experience; and 3) overall understanding of the process of care. Spanish- and English-speaking families had similar patient satisfaction experiences, but the Passport families reported improved quality of communication with the medical care team. CONCLUSIONS The Patient Passport Program enhanced the quality of communication among minority families of hospitalized children with some common themes around the medical care expressed in the Passport book.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass.
| | | | | | - Urmi Bhaumik
- Division of Adolescent Medicine, Boston Children's Hospital, Boston, Mass
| | - Hiep T Nguyen
- Division of Pediatric Urology, Cardon Children's Hospital, Mesa, Ariz
| | - Valerie L Ward
- Department of Radiology, Boston Children's Hospital, Boston, Mass
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12
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Woods ER, Bhaumik U, Sommer SJ, Chan E, Tsopelas L, Fleegler EW, Lorenzi M, Klements EM, Dickerson DU, Nethersole S, Dulin R. Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma. MMWR Suppl 2016; 65:11-20. [DOI: 10.15585/mmwr.su6501a4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Elizabeth R. Woods
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Urmi Bhaumik
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MassachusettsOffice of Community Health, Boston Children’s Hospital, Boston, Massachusetts
| | - Susan J. Sommer
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Elaine Chan
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lindsay Tsopelas
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Margarita Lorenzi
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | | | | | - Shari Nethersole
- Office of Community Health, Boston Children’s Hospital, Boston, MassachusettsGeneral Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Rick Dulin
- Division of Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Castaneda-Sceppa C, Hoffman JA, Thomas J, DuBois M, Agrawal T, Griffin D, Bhaumik U, Healey CL, Dickerson D, Nethersole S, Wirth C. Family gym: a model to promote physical activity for families with young children. J Health Care Poor Underserved 2014; 25:1101-7. [PMID: 25130227 DOI: 10.1353/hpu.2014.0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This report describes Family Gym, a family-centered model that (1) provides free access to physical activity for low-income families in the inner city; (2) targets young children (3-8 years) and their families; (3) engages families together in physical activity; and (4) stimulates social interaction among families.
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14
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Affiliation(s)
- Urmi Bhaumik
- Boston Children's Hospital, Boston, Massachusetts, USA
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15
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Bhaumik U, Norris K, Charron G, Walker SP, Sommer SJ, Chan E, Dickerson DU, Nethersole S, Woods ER. A cost analysis for a community-based case management intervention program for pediatric asthma. J Asthma 2013; 50:310-7. [PMID: 23311526 DOI: 10.3109/02770903.2013.765447] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluate the costs and benefits of the Boston Children's Hospital Community Asthma Initiative (CAI) program through reduction of Emergency Department (ED) visits and hospitalizations and quality of life (QOL) for patients and their families due to reduced missed school days and work days. METHODS Cost-benefit analysis was used to determine an adjusted Return on Investment (ROI) for all 102 patients enrolled in the CAI program in the calendar year 2006 after controlling for changes in a comparable population without CAI intervention. A societal ROI (SROI) was also computed by including additional indirect benefits due to reduced missed school days for patients and work days for caregivers. RESULTS Adjusted cost savings from fewer ED visits and hospitalizations resulted in an adjusted ROI of 1.33 (adjusted Net Present Value, (NPV) of savings = $83,863) during the first 3 years after controlling for factors other than the CAI intervention. When benefits due to reduced missed school days and missed work days were added to adjusted cost savings, the SROI increased to 1.85 (Societal NPV of savings = $215,100). CONCLUSIONS Multidisciplinary, coordinated disease management programs offer the opportunity to prevent costly complications and hospitalizations for chronic diseases, while improving QOL for patients and families. This cost analysis supports the business case for the provision of proactive community-based asthma services that are traditionally not reimbursed by the fee-for-service health care system.
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Affiliation(s)
- Urmi Bhaumik
- Office of Child Advocacy, Boston Children's Hospital, Boston, MA, USA.
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16
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Agrawal T, Hoffman JA, Ahl M, Bhaumik U, Healey C, Carter S, Dickerson D, Nethersole S, Griffin D, Castaneda-Sceppa C. Collaborating for impact: a multilevel early childhood obesity prevention initiative. Fam Community Health 2012; 35:192-202. [PMID: 22617410 DOI: 10.1097/fch.0b013e318250bc25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article presents Healthy Kids, Healthy Futures, a multilevel initiative in Boston, Massachusetts, which brings major institutions' missions and resources together to address early childhood obesity prevention. Programming is designed to facilitate healthy eating and physical activity in preschool children's home, school, and community environments by engaging parents and early childhood educators in the places where they live, learn, and play. This article describes how established interventions were implemented in a novel setting to engage the parents of children attending Head Start and staff, and presents pilot data from the first 2 years of the initiative. Healthy Kids, Healthy Futures is a feasible initiative, which has shown concrete, positive results that can be replicated.
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Affiliation(s)
- Tara Agrawal
- Institute of Urban Health Research, Bouve College of Sciencé, Northeastern University, USA
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17
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Woods ER, Bhaumik U, Sommer SJ, Ziniel SI, Kessler AJ, Chan E, Wilkinson RB, Sesma MN, Burack AB, Klements EM, Queenin LM, Dickerson DU, Nethersole S. Community asthma initiative: evaluation of a quality improvement program for comprehensive asthma care. Pediatrics 2012; 129:465-72. [PMID: 22351890 DOI: 10.1542/peds.2010-3472] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the cost-effectiveness of a quality improvement (QI) program in reducing asthma emergency department (ED) visits, hospitalizations, limitation of physical activity, patient missed school, and parent missed work. METHODS Urban, low-income patients with asthma from 4 zip codes were identified through logs of ED visits or hospitalizations, and offered enhanced care including nurse case management and home visits. QI evaluation focused on parent-completed interviews at enrollment, and at 6- and 12-month contacts. Hospital administrative data were used to assess ED visits and hospitalizations at enrollment, and 1 and 2 years after enrollment. Hospital costs of the program were compared with the hospital costs of a neighboring community with similar demographics. RESULTS The program provided services to 283 children. Participants were 55.1% male; 39.6% African American, 52.3% Latino; 72.7% had Medicaid; 70.8% had a household income <$25 000. Twelve-month data show a significant decrease in any (≥1) asthma ED visits (68.0%) and hospitalizations (84.8%), and any days of limitation of physical activity (42.6%), patient missed school (41.0%), and parent missed work (49.7%) (all P < .0001). Patients with greatest functional impairment from ED visits, limitation of activity, and missed school were more likely to have any nurse home visit and greater number of home visits. There was a significant reduction in hospital costs compared with the comparison community (P < .0001), and a return on investment of 1.46. CONCLUSIONS The program showed improved health outcomes and cost-effectiveness and generated information to guide advocacy efforts to finance comprehensive asthma care.
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Affiliation(s)
- Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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Sommer SJ, Queenin LM, Nethersole S, Greenberg J, Bhaumik U, Stillman L, Hoppin P, Chan E, Wilkinson RB, Woods ER. Children's hospital boston community Asthma initiative: partnerships and outcomes advance policy change. Prog Community Health Partnersh 2012; 5:327-35. [PMID: 22080782 DOI: 10.1353/cpr.2011.0044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PROBLEM Rates of poorly controlled asthma among low-income children, particularly racial and ethnic minorities, remain disproportionately high. Comprehensive asthma programs, including education, case management and home environmental interventions have reduced disparities. Few sustainable payment models exist. PURPOSE The Children's Hospital Boston's Community Asthma Initiative (CAI) demonstrated dramatic reductions in hospitalizations and emergency department (ED) visits among African American and Latino patients with a return on investment (ROI) of 1.46. A strong coalition focused on sustainability plus CAI outcomes contributed to the state legislature's approving a bundled payment pilot for high-risk pediatric asthma patients on Medicaid/MassHealth. KEY POINTS Cost-effective, comprehensive asthma programs and policy makers' interest in new payment models created an opportunity for a new payment approach for pediatric asthma care. CONCLUSION A community coalition that successfully addresses asthma health disparities with a strong business case and program outcomes can be leveraged to persuade policy makers of the value of innovative financing strategies for asthma care.
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Affiliation(s)
- Susan J Sommer
- Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, USA
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Castaneda-Sceppa C, Bhaumik U, Agrawal T, Carter S, Ahl M, Healey C, Nethersole S, Hoffman J. Using a Walk Challenge to Promote Physical Activity among Preschool Staff and Parents/Caregivers. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402547.00166.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVES To examine whether the improved survival of preterm infants has influenced the known male excess in infant mortality. STUDY DESIGN We analyzed sex-specific infant mortality using linked birth and death certificates for all 619,811 live born infants in Massachusetts between 1989 and 1995. RESULTS Between 1989 and 1995 the male excess in infant mortality decreased by 50%, from 1.6/1000 to 0.8/1000 live births (LB). This narrowing resulted primarily from a more rapid decline in neonatal mortality among male infants (1.5/1000 LB) than among female infants (0.9/1000 LB). The largest declines in the male excess in neonatal mortality occurred among very premature infants (GA < or = 30 weeks) and resulted primarily from a more rapid decrease in male deaths from respiratory distress syndrome. CONCLUSIONS The narrowing of the sex difference in mortality between 1989 and 1995 suggests that newer treatments like antenatal steroids, and surfactants may have differentially benefited male infants.
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Affiliation(s)
- Urmi Bhaumik
- Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA 02115, USA
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Bhaumik U, Bose I. Frustrated spin-1/2 model in two dimensions with columnar dimer states as possible ground states. Phys Rev B Condens Matter 1995; 52:12489-12492. [PMID: 9980395 DOI: 10.1103/physrevb.52.12489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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