The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts


Chris Garvey, FNP, MSN, MPA, GeneAnn La Moria, RRT, BS, Charlene Kelly, RRT, Stephen Park, MD Seton Medical Center, Daly City, CA.

BACKGROUND: In the US, the rates of deaths from asthma, hospitalizations and visits to emergency rooms have been increasing for more than 20 years (NHLBI, 2001). A coordinated model of asthma care that focuses on maximizing patient self-management techniques and partnership with the primary care provider (PCP) may reduce overall asthma emergency room visit and hospitalization rates through improved control of asthma.

1844 patients with moderate persistent to severe persistent asthma (based on self-report of daily or more frequent asthma symptoms) were seen for ER care at our private community hospital between 2/98 and 12/03. All patients received a standardized intervention provided by respiratory care practitioners (RCPs) based on the 1997 NIH ‘Guidelines for the Diagnosis and Management of Asthma’. The interventions included: education about disease process and control methods, trigger identification and control, use of MDI and holding chamber, peak flow meter use, importance of reporting of asthma symptoms to the PCP, need for follow-up with PCP, regular use of ‘controller’ medication, and referral to free community asthma education class. Phone follow-up within 4 days of ER asthma visit included assessment of asthma-related symptoms, medication and peak flow adherence, patient follow-up with PCP, and education of disease self-management techniques. For all patients in the sample, 55% (n=1029) received telephone follow-up within 4 days of ER visit. Forty-five percent (n=815) did not answer 3 phone calls. Three months after the initial ER asthma visit and intervention, respiratory ER and respiratory hospitalization revisit rate were assessed by medical record review of all patients.

For the total sample, ER revisit rate for respiratory illness within 3 months of ER asthma intervention decreased 50% and hospital admission for respiratory illness decreased 66% after the first year of the study and the decline was maintained for the following 5 years of the study.

CONCLUSION: Patients demonstrate decreased respiratory ER visits and respiratory hospitalizations after a standardized asthma ER intervention provided by RCPs.

Asthma ER Visit and Hospitalization Rate Three Months after Intervention

Year 1st qtr 1998 1998 1999 2000 2001 2002 2003
ER revisit 53% 18% 9% 8% 3% 4% 6%
Resp Hosp 11% 6% 2% 2% 3% 1% 1%

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