2003 OPEN FORUM Abstracts
COST SAVINGS PARALLEL IMPROVED OUTCOMES IN SEVERE ASTHMA UTILIZING RESPIRATORY CARE PRACTITIONERS
C.Kivler RRT, C.M.Vukovich RRT, S.W.Kutler RRT, N.J.Kenyon MD, S.M. Naguwa MD,
S.Louie MD University of California, Davis Health System - Sacramento, CA
High-cost patients were identified by primary care physicians or health care resource utilization and referred to the UC Davis Asthma Network (UCAN), a multidisciplinary clinical service utilizing Respiratory Care Practitioners (RCPs) to manage poorly controlled asthma patients in a large university health system serving an urban population. RCPs provide acute care in the Emergency Department (ED) and assess and educate patients with severe asthma in outpatient UCAN clinics. From May 1999 to June 2002, UCAN prospectively treated 210 patients in the outpatient clinic by referral. 169 of these patients have been tracked for more than 6 months and 142 patients have been tracked for 1 year or more. This group (175 women, 35 men; age range 16 to 80) accounted for 409 ED visits and 155 hospitalizations for asthma in the previous 12 months before UCAN clinic. 57% had severe persistent disease and 34% had moderate persistent disease. Outpatient education and combination controller therapy reduced the need for urgent care to 31 visits, a reduction of 92% and hospitalizations to 5, a reduction of 97%. Direct cost savings from reduced health care resource utilization were $207,900 and $1,107,750, respectively. All patients obtained a written asthma action plan combining PEFR monitoring, allergy evaluation and combination drug therapy, i.e. fluticasone or budesonide +/or salmeterol or fomoterol +/or montelukast. Only 5% of patients entered UCAN clinic on a leukotriene-modifying drug; 73% left UCAN clinic on montelukast in combination with first-line ICS +/or long acting B2 antagonist. Perception of asthma control and anxiety in this group showed a mean change of 1.34 (p=.0001) measured by the Asthma Quality of Life Questionnaire and the State/Trait Anxiety Index (Juniper) through data analysis employing multiple analysis of variance (MANOVA). No deaths occurred in the period of study.
Cost savings and improved clinical outcomes validate the important role RCPs have in primary care intervention in the UC Davis Health System. UCAN is a viable managed care model for improving the quality & value of asthma care while achieving significant economic savings through patient education & improvement in healthcare navigation and utilization.