Hospital-based Asthma Education: Medical Records
In their program “You Can Control Asthma,” Taggart and colleagues undertook a self-management program that staff nurses on a pediatric ward could provide for the children while they were hospitalized for asthma. This study was unique in that it involved all of the nurses on all of the shifts in the program and they in turn provided the education in short “bursts” of 1 to 10 min while carrying out other nursing duties with the children. Outcome recording was made relatively simple by including it in regular charting. The methods used included videotapes, activity books, and one-on-one nurse instruction. Feasibility and impact were evaluated in 40 children aged 6 to 12 years. Testing retrospectively before and again after the program showed increased knowledge about asthma, increased response to early warning signs during acute exacerbations, and improved locus of control. Parent-reported increased use of selfmanagement techniques for acute exacerbations and medical records compared for 15 months before and after showed a significant reduction in ED utilization. Children were hospitalized for an average of 3 days during which education occurred intermittently. Three months after the hospitalization, a telephone interview parent test was undertaken and 30 months after the index hospital visit, a medical record review was undertaken for the previous 30 months to compare the 15 months prior to the index visit and the 15 months afterwards. Overall, ED visits decreased from 3.1 to 2.2 (p=0.06) while ED visits for severe asthma (n=15) showed a reduction from 6.2 to 3.1 (p<0.01). There was no significant difference in hospitalization for the total group or the group with severe asthma, however.
A second hospital-based program to decrease hospital readmissions for asthma exacerbations in adults by Mayo and coworkers evaluated 104 adults who previously had required multiple hospital admissions. Forty-seven were enrolled in an intensive outpatient therapy clinic vs 57 receiving “standard” care. Nineteen of the latter were subsequently crossed over. Patients received an intensive medical and educational program to teach them aggressive selfmanagement for severe exacerbations. Teaching occurred by the clinic physician or a nurse clinician, but no special written materials were used. The main outcome measure was the hospital readmission rate and the hospital days utilized. Patients in the experimental group showed a threefold reduction in hospital readmission rate (p<0.004) and a twofold decrease in hospital days’ utilization (p<0.02).