Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: Missouri (cont’d)
Barnes-Jewish Hospital Asthma Intervention Program
St. Louis, MO
Nina Zimmermann, MSN, RN, AE-
From 1996 to 1999 a study was done of the Barnes-Jewish Hospital Asthma Intervention Program in St. Louis, MO. The aim was to decrease rates of readmissions within six months of hospital discharge, to reduce cost, and to improve health-related quality of life.
Participants included 96 adult subjects (predominantly young African-American women) who were hospitalized with an asthma exacerbation and had a history of frequent healthcare use. Patients were randomized to an asthma nurse specialist intervention (n = 50) or a usual care group (n = 46) for six months.
Activities were conducted by nurse specialists during patients' hospital stay for asthma. In addition to providing asthma education and establishing an individualized self management plan the nurse specialist provided psychosocial support, screening of patients for professional counseling and consultation with social services for discharge planning. After discharge from the hospital patients followed-up with their primary care physician, and received phone contact and home visits as needed for the subsequent six months. Home visits were done if the patient was not available by phone, to establish trust, and/or to evaluate for potential environmental or social factors which might contribute to poor asthma control.
The randomized, controlled, prospective trial demonstrated a 60% reduction in total hospitalizations (31 readmissions in the intervention group and 71 in the control group, p = 0.04), with no significant change in emergency department visits. Readmissions for asthma were reduced by 54% (21 vs. 42 in the control group; p = 0.04). There was also a marked reduction in lost work or school days: 246 versus 1,040 days in the control group (p = 0.02). The intervention resulted in a substantial reduction in direct and indirect healthcare costs, saving $6,462 per patient (p = 0.03).
The authors concluded that a brief intervention program focusing on high healthcare users with asthma can result in improved asthma control and reduced hospital use with substantial cost savings.
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