1996 OPEN FORUM Abstracts
A PEDIATRIC ASTHMA CLINIC PILOT REDUCES EMERGENCY DEPARTMENT VISITS, HOSPITALIZATIONS, & COST OF CARE
Teresa A. Volsko, RRT, St. Elizabeth Health Center, Youngstown, OH Robert L. Chatburn, RRT, University Hospitals of Cleveland, OH
Asthma affects approximately three million children each year and has contributed to increased health costs due to emergency treatment and hospitalizations. The purpose of this study was to determine whether a physician directed medical plan integrated with self management education could improve patient outcomes in a clinic setting. We hypothesized a reduction in emergency room visits and inpatient hospitalizations along with subsequent costs. Methods: Patients entered into the study were pediatric clients, aged 1-18 years, with a history of asthma and no documented medical treatment plan. Children with chronic pulmonary and/or cardiac problems or neurological impairments were excluded from the study group (ie, cystic fibrosis, congenital cardiac defects, or cerebral palsy). Patients visited the clinic an average of 3 times. A detailed assessment and individualized plan was compiled for each child by a multidisciplinary team directed by a pediatrician with input from the patient and family. An educational plan was created and implemented by the respiratory therapist. It covered early recognition of signs and symptoms, physiological components of an acute exacerbation, precipitant recognition, and a 5 step action plan incorporating the use of peak flow measurements and medication. The dietitian provided recommendations for weight reduction, food allergies, and meal planning as needed. The social worker helped with transportation, insurance, and medical equipment issues. The nurse obtained intake data and administered immunizations. Outcome data were collected on each subject, for equivalent time spans prior to and after participation in the Asthma Clinic. Each patient served as their own control. Clinic data were collected over a seven month pilot period. Before and after clinic data were evaluated with paired t-tests. Results: The demographic and outcome data are shown below:
number of patients 27 race(%)
mean age (years) 8.1 Caucasian 11
Outcome Variables Before After p value
Total ED visits/pt 56 4 -
ED visits/pt 2.1 0.1 < 0.0001
Total hospitalizations 11 1 -
Hospitalizations/pt 0.4 0.04 0.0095
Estimated ED cost/pt $450 $22
Estimated hospital cost/pt$1,240 $124
Total Cost/pt(ED & inpatient) $1,690 $146
There was a concomitant improvement in the patient/family's compliance in keeping regularly scheduled pediatric clinic appointments (50% no-show before, 25% after).
Conclusions: These preliminary results suggest that asthma education in an outpatient clinic setting fosters an understanding of the disease process and improves compliance to medical management. It significantly reduces use of emergency department services, hospitalizations, and thus cost of care. Estimated total cost savings per patient was $1,544.