REDUCTION IN RESOURCE UTILIZATION BY AN ASTHMA OUTREACH PROGRAM

Objective: To study the effect of an asthma outreach program on emergency ward and hospital utilization. Design: Before and after trial. Setting: Ambulatory patients in a staff-model health maintenance organization with a 70% black inner-city population. Patients: Fifty-three patients aged 1 to 17 years with the diagnosis of asthma based on usual clinical practice criteria. Intervention: Asthma emergency ward visits and hospitalizations were monitored over a 6-month to 2-year period after enrollment in the program. Patients were scheduled for one-on-one orientation visits with the asthma outreach nurse and instructed in asthma management, medications, triggers, and use of inhalers and peak flowmeters. An individualized step-care treatment program was outlined for each patient by the nurse, primary care pediatrician, and, when appropriate, an allergist. The outreach nurse maintained personal or telephone contact with the families on a regular basis to assure understanding of and compliance with the treatment plan. Outcome Measures: Outcome was assessed by measuring annualized emergency ward and hospital admissions for each patient for an equal period before and after entry into the program. Results: Emergency ward admissions were reduced 79% (from a rate of 72 visits per year to 15 visits per year, P<.0001) and hospital admissions were reduced 86% (from 35 per year to five per year, P<.001). These reductions were achieved by a single outreach nurse working an average of 8 hours per week at an annualized cost of $11 115; this saved approximately $87 000 in costs. Conclusions: Patients enrolled in a pediatric asthma outreach program experienced a significant reduction in utilization of emergency ward and hospital admissions, resulting in reduced cost of care.