REDUCTION IN RESOURCE UTILIZATION BY AN ASTHMA OUTREACH PROGRAM

Objective: To study the effect of an asthma outreach program on emerge ncy ward and hospital utilization. Design: Before and after trial. Set ting: Ambulatory patients in a staff-model health maintenance organiza tion with a 70% black inner-city population. Patients: Fifty-three pat ients aged 1 to 17 years with the diagnosis of asthma based on usual c linical practice criteria. Intervention: Asthma emergency ward visits and hospitalizations were monitored over a 6-month to 2-year period af ter enrollment in the program. Patients were scheduled for one-on-one orientation visits with the asthma outreach nurse and instructed in as thma management, medications, triggers, and use of inhalers and peak f lowmeters. An individualized step-care treatment program was outlined for each patient by the nurse, primary care pediatrician, and, when ap propriate, an allergist. The outreach nurse maintained personal or tel ephone contact with the families on a regular basis to assure understa nding of and compliance with the treatment plan. Outcome Measures: Out come 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) an d hospital admissions were reduced 86% (from 35 per year to five per y ear, P<.001). These reductions were achieved by a single outreach nurs e 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 signific ant reduction in utilization of emergency ward and hospital admissions , resulting in reduced cost of care.