Improving asthma management: one health plan's experience.
OBJECTIVE
To demonstrate that including the patient's perspective of disease control (patient-reported symptoms) in asthma treatment and management decisions improves patient outcomes and reduces healthcare resource utilization.


METHODS
Two study phases gathered patients' assessments of disease control. Phase 1 used a retrospective physician questionnaire. Phase 2 used a patient questionnaire at each office visit. Physicians and patients were members of the Independent Health Association, a health insurer in upstate New York.


METHODS
Phase 1 gathered patients' assessment of asthma control retrospectively using a physician questionnaire. Physicians received a list of pediatric patients in their practice who had intermittent and persistent asthma as their primary diagnosis. They reviewed a sample of these actively managed patients and answered 10 questions about them. Phase 2 was designed to include the patient's perspective. The Asthma Control Test was sent to every patient with asthma to complete and to bring to each physician visit.


RESULTS
In phase 1, emergency department visits and hospitalizations for asthma decreased during the program. Emergency department visits decreased from 3.71 to 2.92 per year (P < .01), and hospitalizations decreased from 0.83 to 0.81 per year (not statistically significant). Results for phase 2 are not yet available.


CONCLUSIONS
Although not a controlled program, for the participating practices the Independent Health Association health plan seems to have improved patient outcomes when they included retrospective, documented, patient-reported symptoms in their asthma management decisions. Emergency department visits and hospitalizations decreased. Managed care organizations should consider adding the patient's perspective of disease control to their asthma management decisions.
Green
Andrew W
AW
Independent Health Association, 511 Farber Lakes Dr, Buffalo, NY 14221, USA. agreen@ independenthealth.com
Foels
Thomas J
TJ
D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010358:Patient Participation / Q000523:psychology*; D010372:Pediatrics / Q000379:methods; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D013221:State Health Plans; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology