Dinelli Darin L, Higgins James C
Naval Hospital Jacksonville, 2080 Child Street, Jacksonville, FL 32212, USA.
Mil Med. 2002 Mar;167(3):231-4.
Asthma is a chronic inflammatory disease of the airways that affects between 14 and 15 million persons in the United States. It is responsible for more than 470,000 hospitalizations annually and an estimated $6 billion in total medical cost. The Asthma Case Management Program instituted at our hospital is based on the concept of patient self-management. It involves patient education, a home treatment plan (HTP), and physician/nurse follow-up. This study was performed to determine whether an organized case management program improves outcomes and cost in family practice asthma patients.
A prospective cohort study of 48 asthmatic patients was conducted with a retrospective review. Data were obtained from health, pharmacy, and computer records.
Forty-eight asthma patients, ages 1 year to adult, assigned to the Family Practice Department were enrolled in the Asthma Case Management Program. This cohort was offered asthma education from a provider trained in national asthma guidelines. Most of these patients received a coordinated HTP completed by their primary care provider. The asthma case manager initiated regularly scheduled nursing follow-up. Hospital admissions, emergency department and clinic visits, number of chest radiographs, and use of beta 2 agonists and anti-inflammatory drugs were recorded for a mean of 6 months before and 6 months after the intervention. Twenty-eight patients who had received the HTP as part of their intervention were compared with 12 patients who did not. A cost analysis was completed.
All measured parameters showed favorable changes after intervention. Statistically significant decreases in clinic visits, chest radiographs ordered, beta 2 agonists, and oral anti-inflammatory drugs were obtained with the 28 patients who received the HTP. Six-month resource savings after intervention were estimated at $19,677.42 ($491.90 per patient). Ninety-three percent of these savings are attributed to those patients with the HTP. There were no statistically significant improvements and considerably fewer savings for those patients not on the HTP.
A combined intervention consisting of patient education, a coordinated self-monitoring plan, and patient follow-up was associated with improved care and economic outcomes in this group. The greatest clinical improvement and resource savings are clearly seen in those patients who have received the HTP as part of their asthma case management. Every effort should be made to include the HTP as the central part of asthma case management.
哮喘是一种气道慢性炎症性疾病，在美国影响着1400万至1500万人。它每年导致超过47万例住院治疗，医疗总费用估计达60亿美元。我院实施的哮喘病例管理项目基于患者自我管理的理念。该项目包括患者教育、家庭治疗计划（HTP）以及医生/护士随访。本研究旨在确定一个有组织的病例管理项目是否能改善家庭医疗中哮喘患者的治疗效果并降低成本。
对48例哮喘患者进行了前瞻性队列研究，并进行回顾性分析。数据来自健康记录、药房记录和计算机记录。
48例年龄从1岁至成年人、分配到家庭医疗科的哮喘患者参加了哮喘病例管理项目。该队列接受了由接受过国家哮喘指南培训的医护人员提供的哮喘教育。这些患者中的大多数接受了由其初级保健提供者完成的协调一致的家庭治疗计划。哮喘病例管理员启动了定期的护理随访。记录了干预前6个月和干预后6个月的住院次数、急诊科和诊所就诊次数、胸部X光片数量以及β2激动剂和抗炎药物的使用情况。将28例作为干预一部分接受了家庭治疗计划的患者与12例未接受该计划的患者进行了比较。完成了成本分析。
干预后所有测量参数均显示出有利变化。接受家庭治疗计划的28例患者在诊所就诊次数、开具的胸部X光片数量、β2激动剂和口服抗炎药物方面有统计学意义的显著下降。干预后6个月节省的资源估计为19677.42美元（每位患者491.90美元）。这些节省的93%归因于接受家庭治疗计划的患者。未接受家庭治疗计划的患者没有统计学意义的改善，节省的费用也少得多。
由患者教育、协调的自我监测计划和患者随访组成的综合干预措施与该组患者护理的改善和经济效果的提升相关。在作为哮喘病例管理一部分接受了家庭治疗计划的患者中，能明显看到最大程度的临床改善和资源节省。应尽一切努力将家庭治疗计划作为哮喘病例管理的核心部分。
