Testimony on Comparative Effectiveness Research
Sara Rosenbaum, JD; Floyd J. Malveaux, MD, PhD; Feygele Jacobs
Comparative effectiveness research is imperative to better understand and improve the provision of care for children with asthma. We recommend prioritizing studies that compare, with respect to both cost savings and clinical outcomes, the effectiveness of an integrated asthma counselor/environmental mitigation chronic disease management model with a non-integrated episodic model for children with asthma. Childhood asthma is a significant chronic disease that has reached epidemic proportions in heavily disadvantaged communities, placing a disproportionate burden on low-income and minority families and communities. Childhood asthma carries high direct and indirect clinical, social, and economic costs—;an estimated $20 billion in 2007 alone—in the form of preventable emergency department visits and inpatient hospital admissions, lost productivity, school absenteeism and family stress. Paradoxically, while much is known about effective integrated pediatric asthma management (including USPSTF recommendations for "home-based multi-trigger multi-component environmental interventions" for children with asthma), insurers continue to utilize coverage, cost sharing, and payment design strategies that treat asthma as an isolated episodic illness, and pediatric practice and public health have failed to systematically restructure their approach to emphasize an integrated chronic care/public health intervention.
A proposed model of comparison is an integrated asthma counselor/environmental mitigation chronic disease model with a non-integrated, episodic model of care. This can be accomplished through a range of health services research- including interventions specifically designed to better understand novel treatment pathways and comparisons of the standard of care/ usual care with new models as proposed above. This research should include children of all ages (young children and adolescents) and racial/ethnic minority groups.
The epidemic proportion of asthma among child populations at risk for social risk and heavy disease burden, coupled with the high costs associated with ineffective care, make asthma a prime candidate for comparative effectiveness research in pediatric health. The availability of a growing scientific and public health evidence-base, including appropriate models of integrated chronic disease management, also make asthma a priority where it is possible to improve the quality of life for children and families while reducing health care costs.
For more information, please contact: Dr. Floyd Malveaux, MD, PhD (firstname.lastname@example.org)