2012 OPEN FORUM Abstracts
IMPROVED CLINICAL, HEALTH, AND FINANCIAL OUTCOMES FROM A REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM.
Melinda S. Shuler1,2, Susan Sutherland2, Amy S. Trees2,1, Terrence F. Smith2,1, Daniel J. Grady2,1, Donald W. Russell1; 1Regional Asthma Disease Management Program, Mission Hospitals, Asheville, NC; 2Respiratory Care Services, Mission Hospitals, Asheville, NC
Background: A Regional Asthma Disease Management Program (RADMP) was implemented for rural Western North Carolina (WNC) to address the needs of minority children. The program provided services to Native American, African American, and Hispanic children with suboptimal access to care. A multi-faceted approach was used helping families build skills to connect them with community resources for asthma education. Children and families were given care and education in homes, childcare centers, and schools. Collaborators included the NC Asthma Program, Asthma Alliance of NC, WNC School Systems/Child Care Centers, NC Department of Health and Human Services, NC Department of Environmental and Natural Resources, WNC Primary Care Providers, Cherokee Indian Hospital Authority, Faith-Based Organizations, Satellite Clinics, Sub-specialists, and school nurses. Methods: RADMP provided clinical assessment, spirometry, exhaled NO, PFM monitoring, and a symptom diary. Patient ed consisted of the pathophysiology of asthma, identification of triggers, avoidance measures, identification of early/ late warning signs of an asthma exacerbation, and patient empowerment to self-manage. Medication review, assessments, and recommendations were made based on the EPR-3 NHLBI guidelines. An individualized Asthma Action Plan was implemented. Environmental assessments of the patients home and school/childcare setting were completed. Communication of pertinent information to physicians, families, school nurses, and others was completed. Program outcomes were determined over a two year period by comparing costs and clinical outcomes before/after program intervention. The program was structured with a staggered enrollment of fifty patients (n=50). Results: The program resulted in decreased ED visits by 94%, and ED visit cost avoidance of $ 142,006. Hospitalizations decreased by 95%, with a charge avoidance of $687,477. PFT results improved by 21%. Eosinophilic inflammation decreased by 3.4%. Average missed school days decreased by 47%, Conclusions: A regional, pediatric, asthma disease management program resulted in decreased ED costs, hospitalizations, school absences, eosinophilic inflammation, and improved lung function measures. This program improved access to asthma disease management services for minority pediatric patients in WNC. This program won first place in the EPA 2012 National Environmental Leadership Award for Asthma Management, Health Care Provider. Sponsored Research - Sponsor: Mission Foundation and partial funding also provided by the National Asthma Control Initiative (NACI) is funded by the National Asthma Education and Prevention Program of the National Heart,Lung and Blood Institute.