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A Comprehensive Educational Program Improves Clinical Outcome Measures in Inner-City Patients With Asthma
Maureen R. George, MSN, RN, CS;
Liza C. O'Dowd, MD;
Iris Martin, RN;
Kathleen O. Lindell, MSN, RN;
Fay Whitney, PhD;
Martha Jones;
Tracey Ramondo;
Lynne Walsh, RN;
Jacqueline Grissinger, RN;
John Hansen-Flaschen, MD;
Reynold A. Panettieri, Jr, MD
Arch Intern Med. 1999;159:1710-1716.
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 management of asthma are therefore necessary to reverse these dramatic and costly trends.
Objective To determine if patients who are admitted to the hospital with acute asthma and receive inpatient education will have improved outpatient follow-up and clinical outcome measures compared with those receiving conventional care.
Methods Patients enrolled in the study had a primary admission diagnosis of asthma and were between ages 18 and 45 years. Exclusion criteria included comorbid disease, inability to speak English, absence of a telephone in the primary residence, or pregnancy. Seventy-seven patients admitted from the emergency department with asthma were randomized to either the inpatient educational program (IEP) or routine care (control group). Patients in the IEP received asthma education, bedside spirometry, a telephone call 24 hours after discharge, and scheduled follow-up in an outpatient asthma program within 1 week of discharge. Those individuals randomized to the routine management group received conventional inpatient asthma care and routine follow-up.
Results The patients enrolled in the IEP had a markedly higher follow-up rate compared with outpatient appointments (60% vs 27%; P=.01) and significantly fewer emergency department visits (P=.04) and hospitalizations (P=.04) for asthma in the 6 months following IEP intervention, as compared with control patients. This represented a substantial cost savings to the managed care organization.
Conclusion Our study suggests that an IEP in the treatment of indigent, inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.
From the Departments of Medical Nursing (Mss George, Martin, Walsh, and Grissinger), Medicine, Pulmonary and Critical Care Division (Mss George and Lindell and Drs O'Dowd, Hansen-Flaschen, and Panettieri), and Social Work (Dr Whitney and Mss Jones and Ramondo), University of Pennsylvania Medical Center, Philadelphia.
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