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Tuesday, December 20, 2016

Care transition interventions for children with asthma in the emergency department

Childhood asthma is a common and costly chronic medical condition, affecting 7 million children and leading to more than 50 billion dollars in direct healthcare costs every year.  It is particularly burdensome for non-Hispanic black and Puerto Rican children, who are four times as likely to visit the Emergency Department (ED) as non-Hispanic white children.  In this month’s issue of the Journal of Allergy and Clinical Immunology, Martin and colleagues review strategies to bridge care from the ED to home and ambulatory settings, like primary care providers (J Allergy Clin Immunol 2016; 138(6): 1518-1525).   They divide these strategies into two domains: care coordination and self-management education.

Five studies were identified regarding care coordination.  Three involved improved scheduling for follow up appointments, one involved allergen skin testing in the ED, and one involved use of a template to improve adherence to guidelines in the ED.  In all five studies, there were mixed results in the improvement in asthma care.  Only one of the four interventions for self-management education showed improvement in asthma care.  An ongoing project, the CHICAGO Plan, attempts to improve asthma outcomes by taking a patient-centered approach toward asthma care coordination and self-management education in the ED.

Everyone agrees that the goal is to avoid ED visits but how exactly we can best achieve that is, as of yet, unknown. Interventions that link care coordination across the health and community sectors may be one way.  Indeed, there’s still a lot of work to be done in order to determine whether such programs are effective, but this review provides a solid basis for further progress.  

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