Objective: To determine if an emergency department- based asthma follow- up clinic could improve outcomes within a high- morbidity pediatric population. Design: Prospective, randomized clinical trial with 6 months of follow- up. Setting: Emergency department of an urban pediatric medical center. Participants: Convenience sample of 488 patients aged 12 months to 17 years, inclusive, with prior physician- diagnos- ed asthma and 1 or more other unscheduled visits in the previous 6 months and/or 1 or more hospitalizations in the prior 12 months. Intervention: Single follow- up clinic visit focusing on 3 domains: asthma self- monitoring and management, environmental modification and trigger control, and linkages and referrals to ongoing care. Main Outcome Measures: The primary outcome measurewas unscheduled visits for acute asthma care. Secondary outcomes included compliance with a medical plan and asthma quality of life. Analysis was by intention to treat with adjustment for baseline differences. Results: Of those randomized to the clinic visit,172 (70.5% ) of 244 attended. The intervention group had significantly fewer mean unscheduled visits for asthma care during follow- up (1.39 vs 2.34; relative risk [RR]=0.60[95% confidence interval (CI), 0.46- 0.77]). At 6 months, significantly more patients in the intervention group reported use of inhaled corticosteroids in the prior 2 days (49.3% vs 26.5% ;RR=2.03 [95% CI, 1.57- 2.62]), no limitation in daytime quality of life (43.8% vs 34.4% ; RR=1.36 [95% CI, 1.06- 1.73]), and no functional limitations in quality of life (49.8% vs 40.8% ; RR=1.33 [95% CI, 1.08- 1.63]). Conclusion: Attendance in the follow- up clinic was high. The intervention decreased subsequent unscheduled health care use while improving compliance and quality of life.
展开▼
