1998 OPEN FORUM Abstracts
HME COMPANY BASED ASTHMA PROGRAM REDUCES THE COST OF CARE
Joseph Lewarski, RRT, Jason Chao, MD, James Stegmaier, RRT, Thomas Kallstrom, RRT, Vicki Lohser, RN, Leila Woehrle, RN. Hytech Homecare and QualChoice Health Plan, Inc., Cleveland, Ohio
Background: In June of 1996, Hytech Homecare, a HME/Respiratory provider, began a pilot program with QualChoice (HMO), a health insurance organization, to provide home based asthma education and intervention. Asthma is the HMO's number one pediatric diagnosis for both service utilization and cost. The purpose of this pilot study was to determine if the program could reduce the utilization of health care services for this population. Our hypotheses were that mean values for cost, emergency department (ED) visits, admissions and primary care physician (PCP) visits would be significantly less after the program. Methods: Patients were identified and referred to the program by the HMO case managers. Physician orders for the program were required. Eligible patients were any identified by the case managers as having multiple health care contacts related to asthma (ED visits, admissions, etc.). The program, known as AsthmaCare, is provided by registered respiratory therapists. A total of 4 to 5 hours of interactive time was spent with patients in their home. Time was divided into 3-4 sessions over a one month period. Sessions began with a review of their current treatment plan and a detailed environmental, clinical and asthma knowledge assessment. Following the initial visit, an individualized education and treatment care plan was developed based on NAEPP recommendations and the specific patient needs. This was reviewed with the patient, case manager, pharmacist, and physician. The cost of the program included therapist time, and if needed, an aerosol machine, peak flow meter, MDI spacer, plastic mattress/pillow case covers, education materials and miscellaneous supplies. Patient cost and resource utilization were supplied by the HMO. Mean costs were compared with a paired t-test; the mean number of ED visits, hospital admissions, and PCP visits were compared with 2-factor ANOVA for repeated measures. Results: Comprehensive pre and post program data were only available for the first 9 participants who completed the program. The mean age was 7.3 years (range 1.6-12.8), 7 were male and 5 were black. Data below are mean (±SD):
Time(months) Cost/Month ED Admit PCP
Pre-Program 10.3 $1,065 1.1 1.6 2.6
(8.8) ($927) (0.6) (1.0) (1.9)
Post-Program 15.3 $55 0.2 0.2 1.2
(1.7) ($41) (0.4) (0.4) (1.3)
The program resulted in a significant cost savings ($1,010/month; p = 0.001) due to a significant reduction in encounters with health care providers (p < 0.0001).
Conclusions: The HME based asthma education program patients demonstrated a significant reduction in resource utilization and cost. For an initial, one time $400 investment, the HMO earned a projected annual cost savings of more than $12,000 per patient. Although this current study is limited by the small sample size, it strongly supports the theory that disease specific education, provided by HME based respiratory care practitioners, can have a substantial impact on the cost of care for asthmatic patients enrolled in an HMO. Further investigation, including control group comparison and long term outcome monitoring are needed to help substantiate these preliminary findings.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.