Restructuring asthma care in a hospital setting to improve outcomes.
OBJECTIVE
To restructure asthma care as the pilot program in hospital-wide redesign aimed at providing better and more standardized care. We chose asthma care to begin our reorganization because it is the highest-volume diagnosis at our hospital and it involves a broad spectrum of services.


METHODS
Key elements of our restructuring included the following: (1) establishing a pulmonary unit with expanded bed capacity from 8 to 22 beds for asthma patients; (2) standardized treatment protocols; (3) availability of direct admission by primary care physicians who maintained management of their patients with the option of consultation with a specialist; and (4) use of case managers who helped patients and their families overcome obstacles to optimum care.


METHODS
A hospital serving a high proportion of Medicaid patients.


METHODS
Children with asthma and their families.


METHODS
Standardized care for asthma; use of case managers to facilitate adherence to treatment.


RESULTS
With the restructured asthma care program, parent satisfaction with treatment was sustained; the average length of stay and use of the emergency department (ED) were reduced; observation unit use increased; and there were fewer readmissions to both the inpatient unit and the ED.


CONCLUSIONS
We conclude that an inner-city hospital can provide optimum care for asthma patients by standardizing treatment, aggregating asthma patients in one location, and providing education and follow-up through the use of case managers. The protocol shifts some costs from expensive services such as the pediatric ICU and the ED to less costly case management and outreach personnel. In the long run, this allocation of resources should help to lower costs as well as improve quality of care.
Evans
R
R
Division of Allergy, Children's Memorial Hospital, Chicago, IL 60614, USA. revans@nwu.edu
LeBailly
S
S
Gordon
K K
KK
Sawyer
A
A
Christoffel
K K
KK
Pearce
B
B
D001249:Asthma / Q000191:economics / Q000209:etiology / Q000628:therapy*; D002641:Chicago; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006742:Hospital Bed Capacity / Q000191:economics; D006754:Hospital Restructuring / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007223:Infant; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D014504:Urban Health