Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Castro, Mario; Zimmermann, Nina; Crocker, Sue; Bradley, Joseph P.; Leven, Charles L.; Schechtman, Kenneth B.

doi:10.1164/rccm.200208-877oc

Cited by 125 publications

(106 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…15,16 Improving patients' ability to use inhalers may help prevent adverse events post-hospital discharge, including hospital readmissions. [17][18][19] Although a handful of randomized trials have demonstrated beneficial effects of hospital-based patient selfmanagement education for asthma, [20][21][22][23] these studies employed multi-faceted, time-intensive interventions that were compared to usual care. While this literature encourages the use of hospital-based education, direction is lacking as to which intervention or component is most effective.…”

Section: Introductionmentioning

confidence: 99%

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

et al. 2012

View full text Add to dashboard Cite

BACKGROUND:Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. OBJECTIVE: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. PARTICIPANTS: Hospitalized adults (age 18 years or older) with asthma or COPD. INTERVENTIONS: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). MAIN MEASURES: The primary outcome was metereddose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. KEY RESULTS: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p= 0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02).CONCLUSIONS: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization healthrelated events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.

show abstract

Section: Introductionmentioning

confidence: 99%

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

et al. 2012

View full text Add to dashboard Cite

show abstract

“…A study from the United States found that participants in an asthma intervention program experienced an improvement in their asthma control, resulting in reduced hospitalization and substantial cost savings. 11 Nevertheless, the effectiveness of a DMP for asthma in a large population remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

et al. 2013

View full text Add to dashboard Cite

BACKGROUND:The primary aim of the disease management program (DMP) for patients with asthma is to improve health outcomes and to reduce costs. Five years after its introduction in Germany, no consensus has yet been reached as to whether DMP has been effective in reaching these goals. OBJECTIVE: To evaluate the DMP for asthma in Bavaria using routinely collected subject medical records. METHODS: A longitudinal population-based study encompassing over 100,000 DMP participants between 2006 (when the program began) and 2010. RESULTS: The prescription rate of oral corticosteroids dropped from 15.7% in 2006 to 13.6% in 2007, and again from 7.5% in 2008 to 5.9% in 2010 (P < .001). The proportion of subjects with asthma selfmanagement education increased from 4.4% to 23.4% (P < .001). Utilization of an individual asthma action plan increased from 40.3% to 69.3% (P < .001). Hospitalization decreased from 2.8% to 0.7% (P < .001). CONCLUSIONS: In the first 4 years of DMP there was an improvement in pharmacotherapy and patient self management. The proportion of subjects requiring hospitalization decreased. Our results suggest that the German DMP for asthma has been effective in enhancing the quality of care in regard to an improved symptom frequency, adherence to guidelines, pharmacotherapy, and hospitalization.

show abstract

“…3 Most evaluated inpatient programs have served adults with mixed success. [4][5][6][7] Of hospital-based programs targeting children, 3 were multifaceted and included provider quality improvement activities, education, and support. [8][9][10] Three other studies, each reaching fewer than 100 children, focused primarily on patient/caregiver education and support in the hospital during the child's stay.…”

Section: Introductionmentioning

confidence: 99%

A Matched-Cohort Evaluation of a Bedside Asthma Intervention for Patients Hospitalized at a Large Urban Children’s Hospital

Davis

Benson²,

Cooney³

et al. 2011

J Urban Health

View full text Add to dashboard Cite

Emergency care and hospitalizations account for 36% of asthma-related medical expenses for children. National asthma guidelines emphasize the need for asthma self-management education at multiple points of care, including the hospital, to help prevent acute exacerbations. The integration of a bedside asthma education program into discharge planning at a busy urban children's hospital aimed to reduce repeat emergency department (ED) visits and hospitalizations by educating the community's highest-risk children and their families about asthma. A trained respiratory professional provided 45 minutes of individualized bedside education to families at the hospital and one follow-up support phone call within 3 weeks after discharge. Children receiving the intervention were matched to a control group of children not receiving the intervention by age and 2 markers of past utilization using data obtained from hospital records. Repeat ED utilization was analyzed using a Cox proportional hazards model controlling for sex, residence, race or ethnicity, and year. Compared to 698 matched controls, no significant improvement was observed in the 698 intervention participants or any subgroups followed for 12 months after the intervention.

show abstract

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Cited by 125 publications

References 19 publications

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

Teaching the Use of Respiratory Inhalers to Hospitalized Patients with Asthma or COPD: a Randomized Trial

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

A Matched-Cohort Evaluation of a Bedside Asthma Intervention for Patients Hospitalized at a Large Urban Children’s Hospital

Contact Info

Product

Resources

About