Change in Approach and Delivery of Medical Care in Children With Asthma: Results From a Multicenter Emergency Department Educational Asthma Management Program

Abstract

OBJECTIVES. The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers.METHODS. The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/ families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003 and phase II (October 1, 2003, to July 8, 2004. Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II.RESULTS. Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention. A LTHOUGH THERE IS no cure for asthma, self-management can prevent acute asthma exacerbations and irreversible damage to airway function, and improve patients' quality of life (QoL). 1,2 Accordingly, children and their families need to be a key focus for self-management education. 3 National Asthma Education and Prevention Program (NAEPP) guidelines provide a blueprint for such education. 1 To evaluate the status of childhood asthma and its care, assess health care provider adherence to guidelines, and create an integrated system of asthma care, the Hawaii Child Asthma Research to Elevate Standards (CARES) program was developed. The program was directed from the University Tertiary Care Pediatric Teaching Center at the John A. Burns School of Medicine, Kapi'olani Medical Center for Women and Children. Because the medically underserved areas of northeast and west Oahu coincide with the highest incidence of asthma within Honolulu County, 4 medical institutions serving these communities were invited to develop the program jointly. A multiethnic, culturally sensitive approach to data collection was developed to obtain accurate information from this diverse population to develop and implement an emergency department (ED)-based asthma education program for patients, families, and ...

Initiating Inhaled Steroid Treatment for Children With Asthma in the Emergency Room

“…One solution to this problem is to begin delivery of preventive care in the acute care setting. 17,18 This concept is consistent with the current national emphasis on creating accountable care systems in which all providers are accountable for the quality, cost, and overall care of a group of patients. A previous costeffectiveness analysis performed by these authors suggests that either prescribing or dispensing ICS at the time of ED discharge is more cost-effective than relying on an outpatient visit for ICS initiation and will result in fewer relapse ED visits and fewer subsequent hospitalizations.…”

Racial and Ethnic Disparities in Current Asthma and Emergency Department Visits: Findings from the National Health Interview Survey, 2001–2010

“…27 approaches have reported short-term improvements in outcome measures including lung function, self-efficacy, absenteeism from school, number of days of restricted activity, and number of visits to an emergency department. [33][34][35][36][37] Several reports indicate that the emergency department can be used as a setting for asthma education 38 with the implementation of a standard curriculum 39 and the use of written care plans. 40 However, resources in the emergency department, including time and staff, are not always ideal for providing long-term care and education for asthmatics.…”

Follow-Up After Acute Asthma Episodes: What Improves Future Outcomes?

“…Boychuk et al (44) reported the results of a multipronged approach in Hawaii that included asthma education for ED staff and community-based health care providers in which the proportion of patients using controller medications and possessing a written action plan increased substantially after intervention. Although the best methods of providing education to providers who manage patients during and after an asthma ED visit have not been identified and data showing a definitive relationship between provider education and reduced subsequent asthma ED visits are lacking, more attention to the role of provider education in improving asthma outcomes in high-risk patients is probably warranted.…”