Case management of asthma for family practice patients: A pilot study

  • Dinelli D
  • Higgins J
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Abstract

Objective: Asthma is a chronic inflammatory disease of the airways that
affects between 14 and 15 million persons in the United States. It is
responsible for more than 470,000 hospitalizations annually and an
estimated $6 billion in total medical cost. The Asthma Case Management
Program instituted at our hospital is based on the concept of patient
self-management. It involves patient education, a home treatment plan
(HTP), and physician/nurse follow-up. This study was performed to
determine whether an organized case management program improves outcomes
and cost in family practice asthma patients. Study Design: A prospective
cohort study of 48 asthmatic patients was conducted with a retrospective
review. Data were obtained from health, pharmacy, and computer records.
Patients and Methods: Forty-eight asthma patients, ages I year to adult,
assigned to the Family Practice Department were enrolled in the Asthma
Case Management Program. This cohort was offered asthma education from a
provider trained in national asthma guidelines. Most of these patients
received a coordinated HTP completed by their primary care provider. The
asthma case manager initiated regularly scheduled nursing follow-up.
Hospital admissions, emergency department and clinic visits, number of
chest radiographs, and use of 02 agonists and anti-inflammatory drugs
were recorded for a mean of 6 months before and 6 months after the
intervention. Twenty-eight patients who had received the HTP as part of
their intervention were compared with 12 patients who did not. A cost
analysis was completed. Results: All measured parameters showed
favorable changes after intervention. Statistically significant
decreases in clinic visits, chest radiographs ordered, beta2 agonists,
and oral anti-inflammatory drugs were obtained with the 28 patients who
received the HTP. Six-month resource savings after intervention were
estimated at $19,677.42 ($491.90 per patient). Ninety-three percent of
these savings are attributed to those patients with the HTP. There were
no statistically significant improvements and considerably fewer savings
for those patients not on the HTP. Conclusion: A combined intervention
consisting of patient education, a coordinated self-monitoring plan, and
patient follow-up was associated with improved care and economic
outcomes in this group. The greatest clinical improvement and resource
savings are clearly seen in those patients who have received the HTP as
part of their asthma case management. Every effort should be made to
include the HTP as the central part of asthma case management.

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Authors

  • D L Dinelli

  • J C Higgins

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