Study objectives: To
restructure asthma care as the pilot program in hospital-wide redesign
aimed at providing better and more standardized care. We chose asthma
care to begin our reorganization because it is the highest-volume
diagnosis at our hospital and it involves a broad spectrum of
Design: Key elements of our restructuring
included the following: (1) establishing a pulmonary unit with expanded
bed capacity from 8 to 22 beds for asthma patients; (2) standardized
treatment protocols; (3) availability of direct admission by primary
care physicians who maintained management of their patients with the
option of consultation with a specialist; and (4) use of case managers
who helped patients and their families overcome obstacles to optimum
Setting: A hospital serving a high proportion of
with asthma and their families.
Standardized care for asthma; use of case managers to facilitate
adherence to treatment.
Results: With the restructured
asthma care program, parent satisfaction with treatment was sustained;
the average length of stay and use of the emergency department (ED)
were reduced; observation unit use increased; and there were fewer
readmissions to both the inpatient unit and the ED.
Conclusions: We conclude that an inner-city hospital can
provide optimum care for asthma patients by standardizing treatment,
aggregating asthma patients in one location, and providing education
and follow-up through the use of case managers. The protocol shifts
some costs from expensive services such as the pediatric ICU and the ED
to less costly case management and outreach personnel. In the long run,
this allocation of resources should help to lower costs as well as
improve quality of care.