Intervention Program Significantly Reduces Asthma-Related Emergency Department Visits

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An intervention program of telephone follow-up of asthma patients seen at an inner-city hospital reduces frequency of emergency department (ED) use and results in better healthcare management and ultimately better asthma control.

The findings were presented here yesterday at CHEST 2006, the 72nd annual meeting of the American College of Chest Physicians.

The hospital in question was the Truman Medical Center–Hospital Hill in Kansas City, Missouri. Principal investigator Rita A. Mangold, RN, Asthma Program Coordinator at the hospital, went to some pains to convince session attendees that her Midwest institution is truly situated in an inner-city environment. "Eleven percent of this inner-city population is living below the poverty line," she pointed out. "The population is also woefully devoid of payer sources. About 39% are fee-for-service patients."

Half of all ED visits at Truman Medical Center, which is affiliated with the University of Missouri in Kansas City, were asthma-related at baseline, with an annual volume of 57,000 visits.

Ms. Mangold's intervention program was instituted in 2002-2003, when 104 asthma patients visited the ED monthly. In contrast, the Pulmonary/Asthma Clinic averaged 60 visits per month by asthma patients.

In the intervention, the asthma program coordinator reviewed the patient's hospital records and discharge instructions. The patients were then called to check on their health status and were helped in making a follow-up appointment with a clinic or primary care provider. Calls were placed by a registered nurse affiliated with the hospital's asthma program.

Patients with a history of high ED use for asthma-related illnesses were counseled and connected with the Pulmonary/Asthma Clinic for outpatient follow-up.

"ED visits were dramatically changed — down by 40%" with the intervention, Ms. Mangold reported, "from 104 monthly visits before intervention to 36 visits this August."

Good follow-up care is crucial to reducing asthma-related ED visits, Ms. Mangold explained.

In addition, the patient was helped with obtaining a payer source for healthcare, connecting them with Medicaid, compassionate care funds, or other sources, she said. "A lot of times, just the phone call made the difference, making the patient feel that somebody is keeping tabs on them" and facilitating a change in their disease management.

Peter R. Smith, MD, chief of the Division of Medicine at Long Island College Hospital, which is located in inner-city Brooklyn, New York, commented to Medscape that "it's tough to transition asthma patients from the ED to ambulatory care. A lot of these patients use the ED as their primary care source."

He pointed out that an intervention program such as this one "could save a lot of money" and reduce the drain on healthcare funds. "It also has the more important result of better control of asthma symptoms," reducing the morbidity and mortality associated with the disease.

Dr. Smith added that asthma is a difficult disease for a patient to manage. Medication dosing, rescue therapy and proper use of the devices involved require close medical supervision. "As a pulmonologist in a tertiary care facility, [I am] always looking for a way to better control asthma.... However, we find that about half of our patients leave wrong phone numbers, so I don't know if this kind of intervention program would work for us."

Ms. Mangold was an Alfred Soffer Award for Editorial Excellence Finalist. She reports no relevant financial relationships.

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