Objective: Asthma is more prevalent, severe and costly in low-income minority children who typically have relied on episodic care instead of routine preventive care for treatment of their asthma. We evaluated the effect of an educational intervention and outreach program on health outcomes and quality of life (QOL) for Medicaid-insured asthmatic children.Methods: Eighty children, aged 2 to 15 years, with moderate to severe asthma by NHLBI criteria were enrolled from 3/95 to 11/95 in a randomized, controlled trial of the intervention program (n=40, intervention; n=40, control). Children and their caretakers in the intervention group participated in an educational session in a tertiary care pediatric allergy clinic and had routine follow-up care provided by a pediatric allergist. An outreach nurse contacted intervention patients monthly to provide assistance with appointments, medication refills and transportation. Patients in the control group continued to receive usual care. Emergency room (ER) visits and hospitalizations for all study patients in the year prior to enrollment were compared to ER visits and hospitalizations in the year after enrollment. (QOL) was followed in the intervention group throughout the follow up period.Results: In the intervention group, 2 children were lost to follow-up. 26 (68%) were male, 36 (95%) were African-American, and 18 (47%) had smoking exposure in the home; controls did not differ significantly with respect to these factors. In the control group, hospitalizations/year total decreased from 21 to 19 and total hospital days, from 72 to 66. However, total hospitalizations in the intervention group decreased from 24 to 8 (p<.02) and hospital days decreased from 91 to 34 (p<.001). ER visits decreased in both groups, but not to a significant extent. Within the intervention group, quality of life improved above baseline in 21/32 (66%) of measurements completed by children and in 48/83 (58%) of those by caretakers.Conclusions: To our knowledge, this is the first randomized, controlled study of an education and outreach program for asthmatic children from a low SES background. The decrease in health care utilization in both groups underscores the importance of controlled studies. This intervention was highly successful at decreasing hospitalizations while improving QOL, and is generalizable to other Medicaid populations.