A randomized, controlled study to evaluate the role of an in-home asthma disease management program provided by respiratory therapists in improving outcomes and reducing the cost of care.
OBJECTIVE
Asthma management programs (AMP) may reduce costs and improve outcomes in patients with moderate to severe asthma. However, it is not known which personnel are best able to deliver such interventions and what settings are most effective. The purpose of this study was to compare the effects of an in-home AMP provided by respiratory therapists (RTs) to an AMP provided by nurses (RNs) and to usual care (UC) provided in physician offices or clinics.


METHODS
Subjects (age 18-64) who had been admitted to the emergency department (ED) or hospital for acute asthma exacerbation were randomized to three groups: AMP-RT, AMP-RN or UC. The AMP groups received five (5) weekly home visits to provide assessment and instruction; the UC group was instructed to return to their physician for routine follow-up. Outcomes assessed at 6 months included hospitalizations, in patient days, hospitalization cost, ED visits and cost, clinic visits, pulmonary function, symptoms, health related quality of life (HRQOL), asthma episode self-management score (AESM), environmental assessment, and patient satisfaction (PS). Variables were compared using ANOVA with a Neuman-Keuls follow-up for multiple comparisons using an intent-to-treat approach.


RESULTS
Upon enrollment, (n = 159) there were no differences (p > .05) between groups for age, gender, pulmonary function or HRQOL (SF-36 and St. Georges Respiratory Questionnaire - SGRQ). At 6 months, both AMP groups (AMP-RN n = 54; AMP-RT n = 46) had significantly fewer (p < 0.05) hospitalizations and in-patient days, lower hospitalization costs, and greater HRQOL physical component summary change scores (PCS) and PS than UC (n = 59). AMP-RT also had greater PEFR, SGRQ Total and SGRQ Symptoms change scores when compared to UC and significantly better AESM and PS scores as compared to AMP-RN and UC.


CONCLUSIONS
An in-home asthma management program can be effectively delivered by respiratory therapists and may reduce hospitalizations, in-patient days, cost and improve measures of HRQOL and PS in a population prone to asthma exacerbation.
Shelledy
David C
DC
College of Health Sciences, Rush University, Chicago, IL 60612-3832, USA. David_Shelledy@Rush.edu
Legrand
Terry S
TS
Gardner
Donna D
DD
Peters
Jay I
JI
D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000451:nursing / Q000503:physiopathology / Q000628:therapy*; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D019468:Disease Management; D004417:Dyspnea / Q000175:diagnosis; D004777:Environment; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D015397:Program Evaluation; D011788:Quality of Life; D012129:Respiratory Function Tests; D012138:Respiratory Therapy; D012648:Self Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology