Case management of asthma for family practice patients: a pilot study

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.