PURPOSE: Improvement in outpatient control of asthma should decrease exacerbation frequency and severity, leading to less utilization of health care resources. We developed a disease management program (DMP) for a medically indigent, multi-lingual adult patient population. Components include telephone management by a trained nursing staff utilizing a computerized decision support tool (DST) that automates asthma management by generating treatment recommendations based on the NHLBI guidelines.
METHODS: Retrospective, with-in group cohort comparison study. Comparison of emergency department (ED) visits and hospital admissions for the year prior to enrollment and after enrollment will be performed. Comparison will be made using Student's t-test with a p value of 0.05 conferring significance.
RESULTS: Two hundred adult patients with a mean age of 48 years were 65% female and 70% were of Central/South American origin. In the year prior to enrollment, 169 patients (85%) went to the ED, which decreased to 47 patients (24%) in the year after enrollment (p < 0.005). There were a total of 470 ED visits for asthma in the year prior to enrollment compared to a total of 67 visits for asthma post enrollment. Prior to enrollment, there were 76 patients hospitalized a total of 119 times, which decreased to 17 patients being hospitalized 22 times after enrollment (p < 0.005).
CONCLUSIONS: In an indigent patient population of predominantly Central and South American origin, nurses implementing a computerized DST via remote monitoring reduce ED visits and hospital admissions for asthma.
CLINICAL IMPLICATIONS: Significant reductions in ED visits and hospitalizations can be achieved by trained nurses using remote monitoring with a computerized protocol that generates a treatment recommendation.
DISCLOSURE: The following authors have nothing to disclose: Edward Cheng, Gregory Bierer
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