The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

AIR (ASTHMA INTERVENTION & RETRAINING) PROGRAM IN AN URBAN EMERGENCY DEPARTMENT IMPROVES ASTHMA QUALITY OF LIFE; DECREASES ED REVISITS, ADMISSIONS AND HOSPITALIZATION DAYS

K. P. Ryan1, J. Kelly2, A. Chong2, D. Paul2


INTRODUCTION
Asthmatics with persistent disease are frequently treated in the ED. There is inconsistent asthma education in disease management strategies, especially for urban populations. Outpatient Asthma Education programs emphasizing an Asthma Action Plan (AAP) have been shown to be effective in improving asthma self-management.

OBJECTIVE
To assess the success of an ED based AIR (Asthma Interventions & Retraining) Program in reducing asthma visit recidivism, hospitalizations and improve quality of life for adult asthmatics with moderate-severe persistent disease.

METHODS
Participants/Setting: An observational study of the AIR in an Urban Academic ED of Adult Asthmatics (>18yo) with >/= 2 ED visits for asthma within 12 months. Patients enrolled from 07/01/05-10/30/06 are included. Patients were offered AIR enrollment within a week of ED visits. AIR consisted of 5 sessions over 6 months. The initial visit focused on the use of the AAP. Monthly small group sessions reinforced use of the AAP.
Outcome Measures: Comparison of Asthma Quality of Life (AQOL), ED asthma visits, hospitalizations, and hospitalization days a year prior and a year after participation. Cost analysis of ED utilization using Medicare/Medicaid reimbursement rates.

RESULTS
122 patients attended at least 1 session. 20 refused further participation after 1 or 2 sessions or were lost to follow up. 9 had other medical conditions (2–mild asthma, 6–COPD and 1–Lung CA) and 2 deaths occurred (1–asthma; 1–non asthma). 72 patients had 3 or more visits. Information on 72 patients is available for 1-year analysis. Total ED visits decreased from 307 to 162 and hospitalizations decreased from 91 to 49. Inpatient days decreased from 254 to 121.
Mean number of ED visits: Pre 3.53 (95%CI 3.44-5.08); Post 2.25 (95%CI 1.41-3.09) p=0.001.
Mean Hospitalizations: Pre 1.26 (95%CI 0.86-1.66); Post 0.681 (95%CI 0.41-0.95) p=0.02.
AQOL score improved from the 1st to the 3rd visit. Physical domain scores improved from 3.01(95%CI 2.79-3.23) to 4.69(95%CI 4.3-5.08) p=0.0001; Emotional domain scores improved from 2.77 (95%CI 2.5-3.04) to 4.53(95%CI 4.09-4.97) p=0.0001
Using Medicare rates for Moderate-Severe ED utilization, decreased ED visits led to a decrease expenditure of $12,900. Cost savings from hospitalization is potentially higher.

CONCLUSIONS
An ED based AIR Program significantly improves AQOL, decreases ED visits, hospitalizations, Inpatient hospital days and reduces cost of care for Asthma.

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