Abstract
I sought to determine whether a physician-directed medical plan integrated with self-management education could reduce emergency department (ED) visits, hospitalizations, and costs related to pediatric asthma care.
Methods
Patients entered into the clinic pilot program were 1-18 years old with a history of asthma and no documented medical treatment plan. Children with chronic pulmonary, cardiac, or neurological impairments were excluded from the study. During 3 clinic visits, a detailed assessment and plan were com-piled for each child by a multidisciplinary team, consisting of a registered res-piratory therapist, dietician, social worker, and nurse and directed by a pedia-trician. The education plan covered early recognition of signs and symptoms, physiologic components of an acute exacerbation, trigger recognition, and a 5-step action plan for using peak flow measurements and medication. Over a 7-month period, data were collected on each subject for equal time spans prior to and after participation in the asthma clinic. Each patient served as his or her own control. Before and after clinic data were evaluated with paired t tests.
Results
Of the 27 patients, 11 were white, 11 Hispanic, and 5 black; the mean age was 8.1 years. Outcome data for ED visits were 56 before the program, 4 after; ED visits/patient were 2.1 before, 0.1 after (p < 0.0001). The estimated ED cost/patient was $450 before, $22 after. Before the program, 11 asthma-related hospitalizations occurred, afterwards 1. Preclinic hospi-talizations/ patient were 0.4; after intervention, 0.04 (p = 0.0095). The esti-mated hospital cost/patient was $1,240; total ED and inpatient costs/patient were $1,690 prior to clinic participation. Postparticipation hospital cost/patient equaled $124; total ED and inpatient costs/patient, $146. There was a con-comitant improvement in patient and family compliance with scheduled clinic visits (50% no-show before, 25% after).
Conclusions
These results sug-gest that asthma education in an outpatient clinic setting fosters an under-standing of the disease, improves adherence to medical management, and reduces use of ED services, hospitalizations, and total cost of care. Estimated total cost-savings/patient was $1,544.
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