Reduction in resource utilization by an asthma outreach program.
OBJECTIVE
To study the effect of an asthma outreach program on emergency ward and hospital utilization.


METHODS
Before and after trial.


METHODS
Ambulatory patients in a staff-model health maintenance organization with a 70% black inner-city population.


METHODS
Fifty-three patients aged 1 to 17 years with the diagnosis of asthma based on usual clinical practice criteria.


METHODS
Asthma emergency ward visits and hospitalizations were monitored over a 6-month to 2-year period after enrollment in the program. Patients were scheduled for one-on-one orientation visits with the asthma outreach nurse and instructed in asthma management, medications, triggers, and use of inhalers and peak flowmeters. An individualized step-care treatment program was outlined for each patient by the nurse, primary care pediatrician, and, when appropriate, an allergist. The outreach nurse maintained personal or telephone contact with the families on a regular basis to assure understanding of and compliance with the treatment plan.


METHODS
Outcome was assessed by measuring annualized emergency ward and hospital admissions for each patient for an equal period before and after entry into the program.


RESULTS
Emergency ward admissions were reduced 79% (from a rate of 72 visits per year to 15 visits per year, P < .0001) and hospital admissions were reduced 86% (from 35 per year to five per year, P < .001). These reductions were achieved by a single outreach nurse working an average of 8 hours per week at an annualized cost of $11,115; this saved approximately $87,000 in costs.


CONCLUSIONS
Patients enrolled in a pediatric asthma outreach program experienced a significant reduction in utilization of emergency ward and hospital admissions, resulting in reduced cost of care.
Greineder
D K
DK
Department of Allergy, Harvard Community Health Plan, Boston, MA, USA.
Loane
K C
KC
Parks
P
P
D000293:Adolescent; D001249:Asthma / Q000451:nursing / Q000517:prevention & control*; D001900:Boston; D002648:Child; D002675:Child, Preschool; D003152:Community Health Nursing; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D015397:Program Evaluation