Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. S127-S134 (doi:10.1542/peds.2005-2000J)
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SUPPLEMENT ARTICLE

Emergency Department Allies: A Controlled Trial of Two Emergency Department–Based Follow-up Interventions to Improve Asthma Outcomes in Children

Marc H. Gorelick, MD, MSCE, FAAPa, John R. Meurer, MD, MBA, FAAPb, Christine M. Walsh-Kelly, MD, FAAPa, David C. Brousseau, MD, MS, FAAPa, Laura Grabowski, MSc, Jennifer Cohn, MLSb, Evelyn M. Kuhn, PhDd and Kevin J. Kelly, MD, FAAP, FAAAAIc

a Department of Pediatrics, Division of Emergency Medicine
b Department of Pediatrics, Division of General and Community Pediatrics and the Center for the Advancement of Underserved Children
c Department of Pediatrics, Division of Allergy/Immunology, Medical College of Wisconsin, Children's Hospital of Wisconsin and Children's Research Institute, Milwaukee, Wisconsin
d National Outcomes Center, Children's Hospital of Wisconsin, and Children's Research Institute, Milwaukee, Wisconsin

OBJECTIVE. We sought to study the impact of emergency department (ED)–based intensive primary care linkage and initiation of asthma case management on long-term, patient-oriented outcomes for children with an asthma exacerbation.

METHODS. Our study was a randomized, 3-arm, parallel-group, single-blind clinical trial. Children aged 2 through 17 years treated in a pediatric ED for acute asthma were randomly assigned to standard care (group 1), including patient education, a written care plan, and instructions to follow up with the primary care provider within 7 days, or 1 of 2 interventions. Group 2 received standard care plus assistance with scheduling follow-up, while group 3 received the above interventions, plus enrollment in a case management program.

OUTCOMES. The primary outcome was the proportion of children having an ED visit for asthma within 6 months. Other outcomes included change in quality-of-life score and controller-medication use.

RESULTS. Three hundred fifty-two children were enrolled; 78% completed follow-up, 69% were black, and 70% had persistent asthma. Of the children, 37.8% had a subsequent ED visit for asthma, with no difference among the treatment groups (group 1: 38.4%; group 2, 39.2%; group 3, 35.8%). Children in all groups had a substantial, but similar, increase in their quality-of-life score. Controller-medication use increased from 69.4% to 81.4%, with no difference among the groups.

CONCLUSION. ED-based attempts to improve primary care linkage or initiate case management are no more effective than our standard ED care in improving subsequent asthma outcomes over a 6-month period.

Key Words: emergency • asthma • intervention • chronic disease management

Abbreviations: ED—emergency department • CM—case management • NAEPP—National Asthma Education and Prevention Program • PCP—primary care provider • CC—care coordination • QoL—quality of life • FAM—Fight Asthma Milwaukee • ITG-CASF—Integrated Therapeutics Group Child Asthma Short Form

Accepted Dec 6, 2005.




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