Background:

Practice-based care coordination facilitates asthma-management knowledge and confidence, improving asthma control in vulnerable populations. A dearth of information is available regarding the efficacy of a hospital- based care coordination model for children with asthma. We sought to identify the effect an asthma care management team had on self-management quality indicators for children hospitalized for an acute asthma exacerbation. We hypothesized that children receiving care management would demonstrate increases in competence with medication administration, adherence with scheduled post discharge clinic appointments and prescribed home health visits, as well as having lower emergency room visit and hospital readmission rates, compared to those not receiving asthma care management.

Methods:

Demographic and outcome data were collected in two phases. Data for Phase I were collected from a retrospective review (1/1/16 — 8/1/16) of children admitted with an acute exacerbation of asthma who did not receive asthma care management. Data for Phase II were collected prospectively (1/1/17-8/1/17) for children admitted with an exacerbation of asthma and receiving care coordination by our asthma care management team (ACMT). Descriptive statistics reported demographics. Fisher's Exact Test analyzed population characteristics and quality indicator outcomes. Wilcoxon Rank Sum analyzed resource utilization outcomes. Statistical significance was established at p < 0.05.

Results:

210 children were hospitalized for an acute asthma exacerbation and received standardized care on the asthma pathway. Phase I, n = 121. Phase II, n = 89. Cohorts were statistically similar for: age (median = 6 years, P= 0.1), gender (P= 0.6), ethnicity (P= 0.4), and pediatric asthma score on admission (median = 3, P= 0.2). 11 children (12%) in Phase II did not receive asthma care management. Outcomes are described in Table 1.

Conclusions:

Hospital based asthma care coordination improved process outcomes. Although not statistically significant, resource utilization outcomes were clinically relevant.

Table 1. A comparison of quality, process and resource utilization measures

Quality and Process Outcome Measures	P Value	Odds Ratio (95% Confidence Interval)
Adherence with Documenting the Role of Rescue and Controller Medications	0.01	13 (5.7, 28.1) *
Adherence with Documenting Medication Administration with Teach-back	0.01	8 (4.3, 15.9) *
Adherence with Scheduled Post Discharge Follow-up Appointments with Asthma Specialist	0.03	2 (1.2, 4.5) *
Completed Asthma School Action Plan to the School Health Nurse	0.01	3 (1.3, 5.4) *
Completed Home Health Visit	0.01	7 (1.5, 30.0) *
Resource Utilization Measures
Post discharge ED visit < 7 days	0.28
Post discharge ED visit < 30 days	1.00
Post discharge ED visit < 90days	0.47
Post discharge hospital readmission < 7 days	1.00
Post discharge hospital readmission < 30 days	0.47
Post discharge hospital readmission < 90days	0.07
* Odds favored Phase II (asthma care management team).

Search results

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Evaluation of the Effectiveness of an Asthma Care Management Team on Patient and Process Outcomes