Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: Colorado (cont'd)
Impact of a Multidisciplinary Day Program on Disease and Healthcare Costs in Children and Adolescents with Severe Asthma: A two-year follow-up study
National Jewish Medical and Research Center
Donna L. Bratton, PhD
For patients whose asthma remains in poor control necessitating high utilization of medical services, a referral to a specialized "center of excellence" is often considered. A decade ago, the authors evaluated their pediatric asthma program (Denver, CO) of long-term hospitalization (median stay of 75 days) and found significant decreases in subjects' medical utilization following this intervention. In an effort to contain treatment costs, the former program was markedly altered to one of abbreviated stay with emphasis on family management of asthma. The purpose of the present study was to determine the outcome of children treated in the revised program with regard to disease severity, quality of life, and subsequent utilization of medical resources.
Children with severe asthma who were admitted to the program and fulfilled study criteria were consecutively enrolled. Ninety-eight children, aged 9 months to 18 years (mean age, 10.9 years), were enrolled. They participated in the program for a mean of 15.6 ( +/- 8 SD), median of 15.0, and range of 2-51 treatment days.
Patients and their families participated in a day treatment program. Medical and psychosocial education was provided. Patients attended three educational classes in addition to receiving feedback through one-on-one contact with nursing staff to improve information base, medications, and self-assessment. The program included a psychosocial component, group therapy meetings, 3-4 times weekly. Rehabilitation needs, such as functional endurance, overall physical fitness, ADLs, etc., were addressed. The individualized therapeutic program was developed with written recommendations for home implementation.
The group showed significant improvement (P < 0.0001) from admission to 1- and 2-year follow-up in median corticosteroid use, asthma functional severity, perceived competence in asthma management, and quality of life for both caregiver and child. Medical record data showed significant improvement (P < 0.0001) at both 1- and 2-year follow-up in median number of corticosteroid bursts, emergency department visits, hospital days, and overall utilization of medical care encounters. A median total medical encounter cost/patient of $16,250 ($6,972-$25,714 inter-quartile range (IQR)) for the year prior to program participation was reduced to $1,902 ($505-$6,524 IQR) at 1-year and $690 ($185-$3,550 IQR) at 2- year follow-up (P < 0.0001).
The authors concluded that multidisciplinary care in a short-term, outpatient, day treatment program can significantly contribute to improvement in asthma severity, quality of life, and reduction in healthcare costs.
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