A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma

Background: Despite improved understanding of the pathophysiology of asthma , morbidity and mortality continue to rise, with disproportionate increases occurring among urban, indigent minorities. New approaches in the manageme nt of asthma are therefore necessary to reverse these dramatic and costly t rends. Objective: To determine if patients who are admitted to the hospital with a cute asthma and receive inpatient education will have improved outpatient f ollow-up and clinical outcome measures compared with those receiving conven tional care. Methods: Patients enrolled in the study had a primary admission diagnosis o f asthma and were between ages 18 and 45 years. Exclusion criteria included comorbid disease, inability to speak English, absence of a telephone in th e primary residence, or pregnancy. Seventy-seven patients admitted from the emergency department with asthma were randomized to either the inpatient e ducational program (IEP) or routine care (control group). Patients in the I EP received asthma education, bedside spirometry, a telephone call 24 hours after dis-charge, and scheduled follow-up in an outpatient asthma program within 1 week of discharge. Those individuals randomized to the routine man agement group received conventional inpatient asthma care and routine follo w-up. Results: The patients enrolled in the IEP had a markedly higher follow-up r ate compared with outpatient appointments (60% vs 27%; P = .01) and signifi cantly fewer emergency department visits (P = .04) and hospitalizations (P = .04) for asthma in the 6 months following IEP intervention, as compared w ith control patients. This represented a substantial cost savings to the ma naged care organization. Conclusion: Our study suggests that an IEP in the treatment of indigent, in ner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.