Improved asthma outcomes in a high-morbidity pediatric population: results of an emergency department-based randomized clinical trial.
OBJECTIVE
To determine if an emergency department-based asthma follow-up clinic could improve outcomes within a high-morbidity pediatric population.


METHODS
Prospective, randomized clinical trial with 6 months of follow-up.


METHODS
Emergency department of an urban pediatric medical center.


METHODS
Convenience sample of 488 patients aged 12 months to 17 years, inclusive, with prior physician-diagnosed asthma and 1 or more other unscheduled visits in the previous 6 months and/or 1 or more hospitalizations in the prior 12 months.


METHODS
Single follow-up clinic visit focusing on 3 domains: asthma self-monitoring and management, environmental modification and trigger control, and linkages and referrals to ongoing care.


METHODS
The primary outcome measure was unscheduled visits for acute asthma care. Secondary outcomes included compliance with a medical plan and asthma quality of life. Analysis was by intention to treat with adjustment for baseline differences.


RESULTS
Of those randomized to the clinic visit, 172 (70.5%) of 244 attended. The intervention group had significantly fewer mean unscheduled visits for asthma care during follow-up (1.39 vs 2.34; relative risk [RR] = 0.60 [95% confidence interval (CI), 0.46-0.77]). At 6 months, significantly more patients in the intervention group reported use of inhaled corticosteroids in the prior 2 days (49.3% vs 26.5%; RR = 2.03 [95% CI, 1.57-2.62]), no limitation in daytime quality of life (43.8% vs 34.4%; RR = 1.36 [95% CI, 1.06-1.73]), and no functional limitations in quality of life (49.8% vs 40.8%; RR = 1.33 [95% CI, 1.08-1.63]).


CONCLUSIONS
Attendance in the follow-up clinic was high. The intervention decreased subsequent unscheduled health care use while improving compliance and quality of life.
Teach
Stephen J
SJ
Division of Emergency Medicine, Center for Health Services and Community Research, Children's Research Institute, Children's National Medical Center, Washington, DC 20010, USA. steach@cnmc.org
Crain
Ellen F
EF
Quint
Deborah M
DM
Hylan
Michelle L
ML
Joseph
Jill G
JG
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000517:prevention & control*; D001512:Bedding and Linens; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004219:District of Columbia; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D004784:Environmental Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000517:prevention & control; D019037:Urban Health Services / Q000458:organization & administration
D000305:Adrenal Cortex Hormones; D014028:Tobacco Smoke Pollution