Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits

Zeiger, Robert S.; Heller, Susan; Mellon, Michael; Wald, Jeffrey; Falkoff, Reuben; Schätz, Michael

doi:10.1016/0091-6749(91)92162-t

Cited by 258 publications

(106 citation statements)

References 11 publications

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“…12 Health maintenance organizations that restrict access to specialists are associated with a decrease in patients' trust and confidence in their primary care physician, lower patient satisfaction, increased desire to leave the managed care plan, and a lower likelihood of recommending the group to a friend. 13,14 Several studies have shown that specialists do a better job than generalists in the management of patients with suspected myocardial chest pain, 15 unstable angina, 16 acute myocardial infarction, 17,18 asthma, 19,20 diabetes, 21 Staphylococcus aureus bacteremia, 22 and osteoarthritis. 23 In contrast, other studies have shown that specialists were no better than generalists were in the management of patients with severe chronic obstructive pulmonary disease 24 or hypertension and non-insulin-dependent diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis

et al. 2001

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Managed care has strongly discouraged generalists from referring patients to specialists in an effort to reduce the costs of health care. The aim of this study was to compare patient outcomes when generalists work together with gastroenterologists or alone in the management of patients admitted to the hospital with decompensated cirrhosis. Consecutive patients admitted to the hospital with decompensated cirrhosis over a 1-year period were identified. We compared the length of stay, cost of hospitalization, incidence of hospital readmission, and mortality for patients who did and those who did not have a gastroenterology (GI) consultation. A GI consultation was requested for 107 of the 197 patients (54.3%). Patients who had a GI consultation had a significantly shorter length of stay (5.6 ؎ 3.5 vs. 10.1 ؎ 5.8 days, P < .001) and a lower cost of hospitalization ($6,004 ؎ $4,994 vs. $10,006 ؎ $6,183, P < .001) than those patients who were managed by generalists alone. The 30-day incidence of readmission (13.3% vs. 27.8%, P ‫؍‬ .01) and mortality (7.5% vs. 16.7%, P ‫؍‬ .045) were significantly lower in the GI consultation group. During a median follow-up of 618 days (range, 2-970), patients who had a GI consultation during hospitalization had a significantly longer time to hospital readmission (P < .001) and improved survival (P ‫؍‬ .02) compared with those who were managed by generalists alone. In conclusion, for patients admitted to the hospital with decompensated cirrhosis, individuals who were managed by generalists in conjunction with gastroenterologists had better outcomes than those who were managed by generalists alone. (HEPATOLOGY 2001; 34:1089-1095.)Chronic liver disease is the tenth leading cause of death among adults in the United States and accounts for 25,000 deaths annually. 1,2 Patients with chronic liver disease often require hospitalization for complications of cirrhosis and portal hypertension, and these patients place an enormous demand on health care resources. The direct cost of care for patients with liver disease was estimated to be $1.4 billion per year, and the indirect costs of early mortality from liver disease were estimated at $2.2 billion annually. 3 These costs probably underestimated the true cost of care for patients with chronic liver disease because they did not include the costs of morbidity, days of work lost, low productivity, or the negative impact of disease on patient health-related quality of life. 4 In 1997, 1.1 trillion dollars were spent on health care, and this accounted for 13.5% of the gross domestic product. 5 In an effort to reduce the costs of health care, managed care has strongly discouraged generalists from referring patients to specialists. Approximately 90% of health maintenance organizations use primary care physicians as gatekeepers, whose role is to authorize access to specialty, emergency, and hospital care, and to diagnostic tests. 6,7 However, the impact of this practice on the outcome of patients with chronic liver disease is not known. The aims of this...

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Section: Discussionmentioning

confidence: 99%

Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis

et al. 2001

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“…specialist teams that direct care and coordination, teach self management strategies, refer to support services, and help patients navigate the health care system have been associated with improved health outcomes for people with prevalent conditions 1,2 such as asthma [3][4][5] and AIDS. 6,7 Lasker outlined the value of these medical and public health partnerships.…”

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confidence: 99%

A Model for a Regional System of Care to Promote the Health and Well-Being of People with Rare Chronic Genetic Disorders.

et al. 2005

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People with rare, inherited chronic health conditions, such as hemophilia, face added physical, social, emotional, and fiscal challenges beyond those that are common to more prevalent chronic conditions. In 1975, a partnership among clinicians, consumers, and government agencies created a nationwide regional health delivery system that increased access to clinical care, prevention, and research, thereby improving health outcomes for people with hemophilia in the United States. Today, more than 130 Comprehensive Hemophilia Diagnostic and Treatment Centers in 12 regions serve 70%–80% of the nation’s hemophilia patients. Health care leaders and advocates for other rare, expensive, chronic disorders may find that regionalization improves survival and reduces disability among affected populations. However, diverse and stable resources are needed to sustain such a model in our profit-oriented US health care arena.

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“…Referral to asthma specialists has been shown to reduce relapses in asthma emergency room visits. 17 Although the proportion referred for follow-up treatment after discharge was still relatively low, many patients who were not referred had regular follow-up by their family physicians or some out-patient clinics.…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

Tsui¹,

Sham²,

Chan‐Yeung

et al. 2002

Hong Kong Journal of Emergency Medicine

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Introduction Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department. Materials & Methods All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines. Results After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group. Conclusions The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.

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Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits

Cited by 258 publications

References 11 publications

Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis

Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis

A Model for a Regional System of Care to Promote the Health and Well-Being of People with Rare Chronic Genetic Disorders.

Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

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