Awareness Program Committed to Reducing Clinical, Economical Burdens of Asthma


Vol. 12 •Issue 2 • Page 14
Allergy & Asthma

Awareness Program Committed to Reducing Clinical, Economical Burdens of Asthma

In 1996, patients with asthma were using the emergency department at Wyckoff Heights Medical Center, Brooklyn, N.Y., like a revolving door. The readmission rate for status asthmaticus was 27 percent, and patients’ conditions frequently were critical, requiring intubations and mechanical ventilation.

The respiratory department decided their asthma management efforts desperately needed to be revamped. They gathered a multidisciplinary team of nurses, doctors and administrators to study the latest research on effective approaches to asthma care. The result was implementation of the Asthma Awareness Program (AAP).

It started with a series of intensive education sessions for hospital staff. Topics included asthma pathophysiology, triggers, medication, and the appropriate usage of peak flow meters, metered dose inhalers and holding chambers.

The next step was education for the patients. Hospital administration increased the respiratory department’s budget to provide free peak flow meters and education to all patients admitted with asthma.

A grant awarded in 1998 gave a substantial boost to the program. It established a formal set of program goals that fit into the medial center’s mission and vision statement:

• prevention of acute exacerbations with decrease of readmission, morbidity and mortality

• education of patients of their disease

• improved treatment through increased access to continuity of care

• becoming the preferred provider of treatment and education for the community.

A program coordinator, adult nurse practitioner and RTs — all bilingual — came aboard. The therapists were assigned to the emergency department to do discharge education, dispense peak flow meters and follow up with patients by telephone.

The nurse practitioner added an asthma clinic, which now meets four times a month. Clinic visits rose from 347 in 1999 to 716 in 2000. In 2001, the visits totaled 535; the decrease is correlated with improved management of patients requiring less intervention. Patients now are monitoring their peak flow measurements and self-intervening, in turn preventing acute exacerbations.

The AAP also began a monthly support group geared toward improving asthma patients’ quality of life. Family members are invited to attend these informal, informative sessions, and attendees are encouraged to ask questions. Topics related to asthma, such as nutrition, exercise and medication interactions, are discussed.

SPREADING THE WORD

The AAP team began marketing their services to local community groups, providing internal symposiums and participating in local health fairs. At these events, RTs present organized programs on various aspects of asthma, distribute literature and offer resources.

Educational materials are bilingual and age-specific, as are promotional items that publicize the AAP and the hospital. The program’s name and telephone number are readily available on cups, pencils and pens to remind patients to make and keep their medical appointments.

Periodic mass mailings offer the AAP’s expertise to community-based organizations, schools, other medical facilities and church groups. In addition, educational materials are mailed to program participants to update their knowledge surrounding asthma.

The AAP also sponsors a monthly lecture series and biannual symposiums on asthma, which are open to hospital staff and the community. They are presented by attending physicians, guest speakers and elected officials. These forums have proven to be extremely successful and welcomed by the community at large. In 2000, 381 participants attended the lectures; in 2001, that number increased to 613 participants.

HARD WORK PAYS OFF

All of these efforts have added up to a significant decrease in 30-day readmission rates for status asthmaticus: from 27 percent in 1997 to 2.3 percent in 2001.

The hospital’s utilization management committee reports on a quarterly basis the number of denials and the number of days denied by diagnosis related group. Review of this aggregate data showed status asthmaticus ranked No. 1 with 29 denials and 75 days denied in 1998 and 36 denials and 52 days denied in 1999. In 2000, status asthmaticus fell to No. 12, with 12 denials and 16 days denied. No denials were recorded for 2001. This fall in denials can be directly attributed to improved documentation of peak flow monitoring by the RT staff.

Periodic surveys that monitor the AAP’s efficiency are conducted in the hospital’s lobby by RTs. The initial survey in 1997 showed 5 percent of those surveyed had some knowledge of asthma. The December 2001 survey showed 83.3 percent of those surveyed had knowledge of asthma.

LOOKING AHEAD

The success of the AAP hasn’t dampened the fervor or imagination of the team. Plans for expansion of the program to concentrate on pediatrics have begun. A pediatric nurse practitioner has been hired, and a proposal for additional grant funding is being prepared. Plans are being formulated for increasing pediatric asthma clinic hours, for developing educational workshops in schools and day care centers, and for adding pediatric sessions to the support group.

The AAP also is seeking funding to establish an asthma hot line to be manned 24 hours per day. It would provide support, education and direction to patients in order to prevent excessive emergency department use.

Community outreach remains paramount to the program. In order to expand these efforts, the AAP hired a bilingual respiratory educator. Support groups, lectures and workshops can be conducted in English, Spanish, Turkish, German, Creole and Hindu. The AAP also provides sign language interpreters.

The team remains committed to reducing the clinical and economic burdens of asthma. Studies have shown subsets of patients are seen repeatedly but lack adequate management. Through identification of these at-risk patients and appropriate education, medication use and continuity of care, we can continue to prevent repeated emergency department visits, acute exacerbations and readmission.

Dr. Antoine is director of the respiratory therapy department at Wyckoff Heights Medical Center, Brooklyn, N.Y.

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