The Breathing Institute at Children's Hospital Colorado, Aurora, Colorado.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Respir Care. 2022 Jun;67(6):682-687. doi: 10.4187/respcare.08778. Epub 2022 Feb 28.
Asthma is the most common chronic disease leading to hospital admissions and readmissions in childhood. Bedside nurses and respiratory therapists are the primary asthma educators, but they may lack time or knowledge to provide comprehensive asthma education and identify barriers to care. Patients and their parent(s) may benefit from comprehensive education and assessment of barriers from a certified asthma educator.
A team of certified asthma educators used a quality improvement method to create an in-patient asthma education consulting service. The in-patient pulmonary consult and medical teams referred subjects ≥ 1 y in age with a new or existing diagnosis of asthma who had been admitted to the ICU or identified as having concerns for poor medication adherence to the asthma consult. The asthma consult provided face-to-face education with the subject and parent(s), addressed barriers to the plan of care, and helped facilitate appointments to an asthma specialist after discharge.
There were 126 subjects eligible for the asthma consult pilot implemented October 1, 2018-April 30, 2020. The asthma consult saw 52 subjects. Subjects who received consults had a higher rate of previous health care utilization and existing specialist for asthma. After the in-patient stay, the odds of returning to the emergency department/urgent care (UC) or hospital within the following 12 months did not differ between asthma consult and control group. However, after adjusting for covariates of age, race, ethnicity, previous health care utilization, and existing specialist, there was a significant difference in the odds of readmission and revisits (adjusted odds ratio 0.39 [95% CI 0.16-0.98], = .04) for the asthma consult group compared to the control group.
Providing comprehensive, face-to-face asthma education and working with subjects and their parent(s) to address barriers to medication adherence and facilitate specialty follow-up post discharge decreased health care utilization.
哮喘是导致儿童住院和再住院的最常见慢性疾病。床边护士和呼吸治疗师是主要的哮喘教育者，但他们可能缺乏时间或知识来提供全面的哮喘教育，并确定护理障碍。患者及其父母可能受益于由认证哮喘教育者提供的全面教育和护理障碍评估。
一组认证哮喘教育者使用质量改进方法创建了一项住院哮喘教育咨询服务。住院肺科咨询和医疗团队将年龄在 1 岁以上、新诊断或现有哮喘诊断、已入住 ICU 或被认为存在药物治疗依从性差的患者转诊至哮喘咨询。哮喘咨询为患者及其父母提供面对面的教育，解决护理计划的障碍，并帮助在出院后预约哮喘专家。
2018 年 10 月 1 日至 2020 年 4 月 30 日，共有 126 名符合哮喘咨询试点条件的患者。哮喘咨询共接待了 52 名患者。接受咨询的患者之前的医疗利用率和现有的哮喘专家就诊率更高。住院后，在接下来的 12 个月内，哮喘咨询组和对照组返回急诊部/紧急护理（UC）或住院的几率没有差异。然而，在校正年龄、种族、民族、之前的医疗利用率和现有的专科医生等混杂因素后，哮喘咨询组与对照组相比，再次入院和再次就诊的几率存在显著差异（调整后的优势比 0.39 [95%CI 0.16-0.98]，.04）。
提供全面、面对面的哮喘教育，并与患者及其父母合作解决药物治疗依从性障碍，并在出院后促进专科随访，可减少医疗保健的利用。
