1998 OPEN FORUM Abstracts
ASTHMA EDUCATION DECREASES ANNUAL EMERGENCY DEPARTMENT VISITS, INPATIENT ADMISSIONS AND HEALTH CARE COSTS.
Diana L. Dlugolenski, RRT; Shirley Pagliano, RRT; Scott Wolf, DO; Pat Hernandez, RN. Hartford Hospital, Hartford, CT.
Background: Enhanced awareness of environmental triggers, as well as early recognition and intervention, will result in significantly lower emergency resource utilization, lower inpatient admission rate, improved functional status, and an overall improvement in quality of life. Method: Referrals to the Asthma Control and Education (ACE) program were received from two areas within the hospital- the flight respiratory therapist/emergency department (FRT/ED) team attending to asthmatic patients in the Emergency Department (ED) and the Medical Team Respiratory Care Practitioners (RCP's) covering inpatient asthmatics. Criteria for ACE referral from the ED included 1. moderate and severe asthmatics based on National Institute of Health Guideline criteria 2. repeated demonstration of non-compliance/misunderstanding of treatment plan or medication use 3. city, state and ward patients and 4. discharge home. Management included initial patient assessment of exacerbation, provide respiratory care as per critical pathway, reassessment of patient and either admit or discharge. Prior to discharging an asthmatic, the Flight Respiratory Therapist (FRT) promotes the ACE program and administers a "quick teach". The quick teach includes metered dose inhaler (MDI) instruction with a spacer, delivering a peak flowmeter and teaching its importance, recognizing triggers, signs and symptoms of worsening asthma and use of medications. A brochure is given to the patient which describes the ACE program and is written in both English and Spanish. As time allows, the FRT may elect to do further teaching. A house/key/broom analogy is one resource to describe the different medications and their roles. Those asthmatics admitted were followed and referred by the medical team. The medical team RCP's worked in collaboration with the nursing staff and MD's to help identify and enroll inner city patients into the program. Prior to discharge, the medical team RCP's would conduct a "quick teach". The ACE program consists of three visits, each focusing on a different issue. Included in the sessions are prior medical history, goal setting, discussion on disease process, pulmonary function testing, medications, triggers, how to handle an exacerbation and a home environmental survey. Results: For the period of 1/23/97 to 10/31/97, 178 patients had at least an initial visit by October 31, 1997. Eighty-eight (49.4%) had an initial visit but did not complete ACE education within 3 months. Ninety (50.6%) are currently enrolled. Forty six have completed the ACE educational program and provided follow-up data by October 31, 1997. The mean age of these 46 patients is 45.5 years (range = 13-72yrs). In 1996, 23 patients pre-ACE had 47 ED visits (3.92 ED visits/month). Total cost $18,859.05. (Ave $401.26) In 1997, these same 23 patients Post-ACE had 17 ED visits (2.06 ED visits/month). Total cost $7,500.20. (Ave $441.89) This is a 47% reduction in the number of ED visits. For patient hospitalizations in 1996, 11 patients pre-ACE had 16 inpatient (IP) visits (1.33 IP visits/month). Total cost $94,753.09 (Ave $5,923.07). In 1997, these same 11 patients post-ACE had 3 IP visits (0.38 IP visits/month). Total cost $4,410.47. (Ave $1470.16) This is a 71% reduction in the number of IP visits and a 95% reduction in total cost. Conclusion: Educating the asthmatic patient on their disease process leads to better medication compliance and avoidance of triggers thus leading to healthier lives, a decrease in annual ED visits and inpatient admissions, and drastically reduces healthcare costs. More investigation and effort is needed to improve the percentage of patients who complete the ACE program.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.