The Science Journal of the American Association for Respiratory Care

2006 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: An estimated 20 million Americans have asthma. 1 Nearly 1.9 million ER visits were attributed to asthma in 2002.2 Objectives of Healthy People 2010 include reducing asthma hospitalizations and ER visits and increasing the number of persons with asthma who receive formal patient education, including community and self-help resources and appropriate asthma care according to the NAEPP Guidelines.3 Coordinated asthma care that focuses on promoting patient self-management strategies and collaboration with the primary care provider (PCP) may reduce overall asthma emergency room visits and hospitalizations through improved control and management of asthma.

2152 patients with moderate 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 12/05. All patients received a standardized intervention provided by respiratory care practitioners (RCPs) based on the NAEPP Guidelines for the Diagnosis and Management of Asthma4. The interventions included: patient education about disease process and control strategies, trigger identification and control, use of MDI, holding chamber and peak flow meter, need for PCP follow-up and prompt reporting of asthma symptoms, regular use of 'controller' medication, and referral to free community asthma education classes. 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, 54 % (n=1170) received telephone follow-up within 4 days of the ER visit. Forty-six percent (n = 982) did not answer 3 phone calls. Three months after the initial ER asthma visit and intervention, respiratory ER and respiratory hospitalization revisit rates were assessed by medical record review of all patients.

For the total sample, ER revisit rate for asthma within 3 months of ER asthma intervention decreased from 18% in 1998 to a current rate of 2% and hospital admissions for asthma decreased from 6% in 1998 to a current rate of 3%. Declines in ER asthma return rates and asthma-related hospitalizations have been maintained for the following 7 years of the study. 

Asthma ER Visit and Hospitalization Rate Three Months after Intervention

Year 1998 1999 2000 2001 2002 2003 2004 2005
Total pts 130 354 421 360 314 264 140 169
ER visit 18% 9% 8% 3% 4% 6% 1% 2%
Resp Hosp 6% 2% 2% 3% 1% 1% 1% 3%

Conclusion: Patients demonstrate decreased asthma ER visits and asthma-related hospitalizations after a standardized asthma ER intervention provided by RCPs.
1.        National Center for Health Statistics. Raw Data from the National Health Interview Survey, U.S., 2003. (Analysis by the ALA, Using SPSS and SUDAAN software).

2.        National Center for Health Statistics. National Hospital Ambulatory Medical Survey, 2002. (Analysis by the American Lung Association, Using SPSS and SUDAAN software).

3.        US Department of HHS. Respiratory diseases [Goal 24]. In: Healthy people 2010 (conference ed., vol II). Washington, DC: US Department of Health and Human Services, 2000;24-1-27.

4.        NIH, National Asthma Education Program. NAEPP Expert Panel Report. Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002. Bethesda, MD.