Emergency department allies: a controlled trial of two emergency department-based follow-up interventions to improve asthma outcomes in children.
OBJECTIVE
We sought to study the impact of emergency department (ED)-based intensive primary care linkage and initiation of asthma case management on long-term, patient-oriented outcomes for children with an asthma exacerbation.


METHODS
Our study was a randomized, 3-arm, parallel-group, single-blind clinical trial. Children aged 2 through 17 years treated in a pediatric ED for acute asthma were randomly assigned to standard care (group 1), including patient education, a written care plan, and instructions to follow up with the primary care provider within 7 days, or 1 of 2 interventions. Group 2 received standard care plus assistance with scheduling follow-up, while group 3 received the above interventions, plus enrollment in a case management program.


RESULTS
The primary outcome was the proportion of children having an ED visit for asthma within 6 months. Other outcomes included change in quality-of-life score and controller-medication use.


RESULTS
Three hundred fifty-two children were enrolled; 78% completed follow-up, 69% were black, and 70% had persistent asthma. Of the children, 37.8% had a subsequent ED visit for asthma, with no difference among the treatment groups (group 1: 38.4%; group 2, 39.2%; group 3, 35.8%). Children in all groups had a substantial, but similar, increase in their quality-of-life score. Controller-medication use increased from 69.4% to 81.4%, with no difference among the groups.


CONCLUSIONS
ED-based attempts to improve primary care linkage or initiate case management are no more effective than our standard ED care in improving subsequent asthma outcomes over a 6-month period.
Gorelick
Marc H
MH
Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin, Children's Hospital of Wisconsin and Children's Research Institute, Milwaukee, Wisconsin, USA. mgorelic@mail.mcw.edu
Meurer
John R
JR
Walsh-Kelly
Christine M
CM
Brousseau
David C
DC
Grabowski
Laura
L
Cohn
Jennifer
J
Kuhn
Evelyn M
EM
Kelly
Kevin J
KJ
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy*; D019090:Case Management; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D011788:Quality of Life; D016037:Single-Blind Method; D014922:Wisconsin
D018927:Anti-Asthmatic Agents