Emergency department observation unit versus hospital inpatient care for a chronic asthmatic population - A randomized trial of health status outcome and cost

被引:71
作者
Rydman, RJ
Isola, ML
Roberts, RR
Zalenski, RJ
McDermott, MF
Murphy, DG
McCarren, MM
Kampe, LM
机构
[1] Cook Cty Hosp, Dept Emergency Med, Chicago, IL 60612 USA
[2] Univ Illinois, Ctr Hlth Serv Res, Chicago, IL USA
[3] Illinois Fdn Qual Hlth Care, Oak Brook, IL USA
[4] Wayne State Univ, Dept Emergency Med, Detroit, MI USA
[5] Maimonides Med Ctr, Dept Emergency Med, Brooklyn, NY 11219 USA
关键词
asthma; observation medicine; emergency medicine; quality of life;
D O I
10.1097/00005650-199804000-00015
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVES. This study was designed to determine if an accelerated treatment protocol administered to acute asthmatics presenting to a Hospital Emergency Department Observation Unit (EDOU) can offset the need for inpatient admissions and reduce total cost per episode of care without sacrificing patient quality of life. METHODS. The authors used a prospective randomized controlled trial comparing postintervention patient quality of life for EDOU care versus standard inpatient care as measured by the standardized Medical Outcomes Study (MOS) SF-36 instrument. Other measures reported include: clinical status as measured by peak flow rates, total cost per treatment arm using microcosting techniques, and relapse-free survival 8 weeks after treatment. Eligible patients (n = 113) were assigned randomly to an EDOU or inpatient care from a consecutive sample of 250 acute asthmatic patients presenting to an urban hospital emergency department who could not resolve their acute asthma exacerbation after 3 hours of emergency department therapy. RESULTS. Patients assigned to the EDOU had lower mean costs of treatment (EDOU = $1,202 versus Hospital Inpatient = $2,247) and higher quality of life outcomes after intervention in five of eight domains measured by the MOS SF-36: Physical Functioning, Role Functioning-Emotional, Social Functioning, Mental Health, and Vitality. No differences were found in clinical outcomes as measured by peak flow rates or postintervention relapse-free survival. Univariate comparative findings were re-examined and confirmed through multivariable analysis when baseline SF-36 scores and postintervention peak expiratory flow rates clinical status were used as covariates. CONCLUSIONS. The study showed that the EDOU was a lower cost and more effective treatment alternative for a refractory asthmatic population presenting to the Emergency Department. Several baseline MOS SF-36 domains proved useful in predicting or validating posttreatment clinical status, relapse, and total costs of care. Outcome SF-36 domain scores were also useful in identifying patients with the most favorable clinical, cost, and relapse rate outcomes at the study endpoint.
引用
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页码:599 / 609
页数:11
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