PROTOCOL THERAPY FOR ACUTE ASTHMA - THERAPEUTIC BENEFITS AND COST SAVINGS

BACKGROUND: TO evaluate the therapeutic and financial benefits of prot ocol therapy for acute asthma using standard medications. MATERIALS AN D METHODS: This study employed a sequential design in which the influe nce of an asthma care path on hospital admissions, length of stay (LOS ) in the emergency department, and return visits were evaluated for 1 year. This information was contrasted with similar data obtained from the 8 months immediately before the protocol was implemented (preproto col) and a 12-month period after strict adherence to it had declined ( admixture). RESULTS: In all, 526 acute exacerbations of asthma were tr eated with the care path, and 429 and 558 episodes were evaluated duri ng the preprotocol and admixture periods, respectively. There were no significant differences between the presenting clinical or physiologic features of any group. With the protocol, 77% of the patients resolve d their symptoms within 1:47 +/- 0.02 hours:minutes of arrival in the emergency department with a 2% return rate within 24 hours. The algori thms used quickly identified those needing hospitalization. Patients n ot meeting the criteria for discharge after receiving the treatments e mployed typically did not resolve their symptoms for days (average hos pital stay 4.1 +/- 0.2 days). Compared with the preprotocol period, th e care path significantly reduced the LOS by 50 minutes, the number of urgent and intensive care unit admissions by 27% and 41%, respectivel y, and the frequency of return visits within 24 hours by 66%. Charges to patients and third-party payers decreased $395,000. When adherence to the protocol diminished, LOS, admissions, and returns rose signific antly toward preprotocol values and the financial benefits were lost. CONCLUSIONS: Asthma protocol therapy, based primarily upon aggressive use of sympathomimetics in association with serial monitoring of key i ndices of improvement, provides prompt and efficient relief for acute exacerbations of asthma. Such an approach yields significant financial benefit while quickly identifying individuals who require hospitaliza tion, and it also detects physician practice patterns that can have po tentially detrimental impacts on patient care.