Improved Asthma Outcomes in a High-Morbidity Pediatric Population: Results of an Emergency Department-Based Randomized Clinical Trial

Abstract

Teach SJ, Crain EF, Quint DM, Hylan ML, Joseph JG. Arch Pediatr Adolesc Med. 2006;160:535–541 PURPOSE OF THE STUDY. To determine if an emergency department–based asthma follow-up clinic could improve outcomes within a high-morbidity pediatric population. STUDY POPULATION. Four hundred eighty-eight patients (aged 12 months to 17 years) from an emergency department at an urban tertiary care pediatric hospital with previous physician-diagnosed asthma and ≥1 unscheduled visit in the last 6 months and/or ≥1 hospitalization in the last 12 months. METHODS. The subjects were recruited while they were still in the emergency department for their acute care visits. The subjects were randomly assigned to either a single visit to an asthma clinic located in the emergency department, where they met with an asthma educator and a physician, or the control group, which received printed information about asthma. Follow-up telephone interviews were conducted at 1, 3, and 6 months after enrollment. RESULTS. One hundred seventy-two (70.5%) of the subjects who were randomly assigned to the intervention attended the clinic, and 167 of these subjects were prescribed inhaled corticosteroids. Compared with children in the control group, those in the intervention group had significantly fewer unscheduled visits for asthma care (mean: 1.39 vs 2.34; relative risk: 0.60); at 6 months, reported significantly more use of inhaled corticosteroids (49.3% vs 26.5%; relative risk: 2.03); reported “no limitation in daytime quality of life” significantly more often (43.8% vs 34.4%; relative risk: 1.36); and reported “no functional limitations in quality of life” significantly more often (49.8% vs 40.8%; relative risk: 1.33). CONCLUSIONS. A single follow-up visit to an emergency department–based asthma clinic resulted in significant improvements in care and outcomes for a high-morbidity pediatric population. REVIEWER COMMENTS. This study was unique in that the emphasis was on follow-up in a clinic in the emergency department where care was first given, rather than a primary care office. This intervention seems to have been more successful than previously published emergency department–based studies that focused on improving rates of follow-up with primary care providers. There are a number of possible explanations for these findings, including the fact that many families use the emergency department as a de facto primary care office and the comprehensive nature of the emergency department–clinic visit. Costs were not analyzed, and there may be other barriers to other emergency departments adopting an intervention of this type, but these results are promising.