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Team approach improved asthma prevention care
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An enhanced team approach for the treatment of patients with asthma improved symptom management among those patients, according to study results presented here. This treatment method resulted in a significant and sustained reduction in urgent care, as well as inpatient hospitalizations and ED visits among high-risk asthma patients.
This approach began with a clinic-wide quality improvement initiative and creation of an inter-professional team to provide coordinated preventative asthma care, enhanced asthma education and case management sessions, according to Helen D’Couto, BS, Harvard University medical student from the Center for Primary Care at Harvard Medical School, who presented the data.
The investigators, led by Faye Holder-Niles, MD, MPH, Center for Primary Care at Harvard Medical School and Boston Children’s Hospital, assessed asthma-related preventive care, urgent care, ED visits and inpatient hospitalization data for 140 high-risk asthma patients who were followed during the study period. Patients were considered high risk if they had a recent ED visit or inpatient admission.
High-risk asthma patients and their families received education on their asthma medications, asthma action plans and tips to better manage their child’s asthma symptoms. The investigators assessed environmental triggers and families received trigger mitigation support in addition to referrals to community resources.
Helen D’Couto
Utilization rates were compared for the year preceding intervention and compared with those at 1 and 2 years post intervention, and a significant decrease from baseline was observed: urgent care (P=.002, 1 year; P <.001, 2yr); ED (P <.001; P <.001); and inpatient hospitalization (P=.002; P=.04) visits. Rates decreased from baseline by 51% for urgent care; 71% for ED; and 50% for inpatient hospitalization at 2 years.
Primary care visits increased 40% from baseline during the intervention (P<.001), but by 2 years following the intervention, primary care visits decreased by 17% from baseline (P=.06).
This increase in preventive visits is a reflection of an increase in care coordination and increased work with the asthma action team that was then followed by a sustained reduction in health care utilization data for asthma.
“Primary care models that integrate enhanced educational sessions for vulnerable patient populations have tremendous potential to improve health outcomes and reduce health disparities while controlling health care cost,” D’Couto said. “It takes some time for us to see these utilization outcomes manifest themselves. What is reassuring is that we see a return to baseline in preventive visits and then sustained reduction.”
D’Couto said that this program really supports the idea of the medical home model and its benefit to high-risk patients in chronic disease management.
Holder-Niles added that the intervention improved the patient-physician relationship in many ways.
“Improving the relationship with the patient made a tremendous difference in medication adherence,” she said.
D’Couto said the next step is to assess the cost savings of care coordination within this program to understand the impact of health care utilization and the social return on investment and expand the team model.
“We learned some valuable lessons and we are working on taking the lessons we learned from the smaller cohort and expanding it to develop a population-based asthma management program that can be implemented clinic-wide,” she said.
D’Couto H. Abstract #1506.76.
Disclosure: D’Couto reports no relevant financial disclosures.