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Published ahead of print on June 13, 2003, doi:10.1164/rccm.200208-877OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 9, November 2003, 1095-1099

A more recent version of this article appeared on November 1, 2003
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Submitted on August 16, 2002
Accepted on May 30, 2003

Asthma intervention program prevents readmissions in high healthcare utilizers

Mario Castro1*, Nina A Zimmermann2, Sue Crocker1, Joseph Bradley1, Charles Leven1, and Kenneth B Schechtman3

1 Medicine, Washington University School of Medicine, St. Louis, MO, USA, 2 Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA; Medicine, Washington University School of Medicine, St. Louis, MO, USA, 3 Biostatistics, Washington University School of Medicine, St. Louis, MO, USA; Medicine, Washington University School of Medicine, St. Louis, MO, USA

* To whom correspondence should be addressed. E-mail: castrom{at}msnotes.wustl.edu.

The largest portion of the cost for asthma healthcare is due to hospitalizations. Improved methods of health care delivery for patients with asthma are needed to prevent readmissions. From 1996 to 1999, 96 adult subjects (predominantly young African-American women) hospitalized with an asthma exacerbation, who had a history of frequent healthcare utilization, were randomized to an asthma nurse specialist intervention (N=50) or usual care group (N=46) for 6 months. Our aim was to decrease rates of readmissions within six months of hospital discharge, reduce cost, and improve health-related quality of life. Our results demonstrate 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). We found a marked reduction in lost work or school days - 246 vs. 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). A brief intervention program focusing on high healthcare utilizers with asthma can result in improved asthma control and reduced hospital use with substantial cost savings.
Key words: Asthma education, healthcare costs, hospitalizations




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