George M R, O'Dowd L C, Martin I, Lindell K O, Whitney F, Jones M, Ramondo T, Walsh L, Grissinger J, Hansen-Flaschen J, Panettieri R A
Department of Medical Nursing, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
Arch Intern Med. 1999;159(15):1710-6. doi: 10.1001/archinte.159.15.1710.
Despite improved understanding of the pathophysiology of asthma, morbidity and mortality continue to rise, with disproportionate increases occurring among urban, indigent minorities. New approaches in the management of asthma are therefore necessary to reverse these dramatic and costly trends.
To determine if patients who are admitted to the hospital with acute asthma and receive inpatient education will have improved outpatient follow-up and clinical outcome measures compared with those receiving conventional care.
Patients enrolled in the study had a primary admission diagnosis of asthma and were between ages 18 and 45 years. Exclusion criteria included comorbid disease, inability to speak English, absence of a telephone in the primary residence, or pregnancy. Seventy-seven patients admitted from the emergency department with asthma were randomized to either the inpatient educational program (IEP) or routine care (control group). Patients in the IEP received asthma education, bedside spirometry, a telephone call 24 hours after discharge, and scheduled follow-up in an outpatient asthma program within 1 week of discharge. Those individuals randomized to the routine management group received conventional inpatient asthma care and routine follow-up.
The patients enrolled in the IEP had a markedly higher follow-up rate compared with outpatient appointments (60% vs. 27%; P = .01) and significantly fewer emergency department visits (P = .04) and hospitalizations (P = .04) for asthma in the 6 months following IEP intervention, as compared with control patients. This represented a substantial cost savings to the managed care organization.
Our study suggests that an IEP in the treatment of indigent, inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner.
尽管对哮喘的病理生理学有了更深入的了解，但发病率和死亡率仍在上升，城市贫困少数群体中的增长尤为显著。因此，需要新的哮喘管理方法来扭转这些严峻且代价高昂的趋势。
确定与接受常规护理的患者相比，因急性哮喘入院并接受住院教育的患者是否会有更好的门诊随访和临床结局指标。
纳入研究的患者主要入院诊断为哮喘，年龄在18至45岁之间。排除标准包括合并疾病、不会说英语、主要居住地没有电话或怀孕。77名因哮喘从急诊科入院的患者被随机分为住院教育项目组（IEP）或常规护理组（对照组）。IEP组的患者接受哮喘教育、床边肺活量测定、出院后24小时电话随访以及出院后1周内安排在门诊哮喘项目中的随访。随机分配到常规管理组的患者接受常规住院哮喘护理和常规随访。
与门诊预约相比，IEP组患者的随访率显著更高（60%对27%；P = 0.01），并且在IEP干预后的6个月内，与对照组患者相比，因哮喘的急诊科就诊次数（P = 0.04）和住院次数（P = 0.04）显著减少。这为管理式医疗组织节省了大量成本。
我们的研究表明，对因哮喘住院的贫困城市患者进行IEP治疗，以具有成本效益的方式减少了后续紧急护理的需求，并改善了门诊随访。
