Engagement with Case Management Reduces Emergency Department Visits for Asthma

Rationale: Millions of children utilize the Emergency Department (ED) for asthma exacerbations annually, increasing healthcare utilization and costs. Patients with a low socio-economic status are more likely to utilize the ED for asthma exacerbations due to long work hours, lack of transportation, and low health literacy.22,24 Long-term involvement with case management can address these issues and bridge gaps in access to preventative care, potentially improving overall asthma outcomes. This study investigated the effects of engagement with case management on asthma outcomes in patients with frequent ED utilization for asthma exacerbations by facilitating access to asthma specialty care. Methods: Subjects who presented to the ED at Children’s Hospital and Medical Center in Omaha, NE for an asthma exacerbation with two previous visits for asthma exacerbations in the previous 12 months were identified through a Best Practice Alert (BPA) in the Electronic Health Record (EHR). The BPA created a referral to case management. The case manager approached subjects either during the ED visit or afterwards through a phone call to refer and facilitate evaluation with asthma specialty care. The intervention group consisted of subjects who engaged with case managers over time and attended at least one appointment with an asthma specialist, while the control group did not engage with case management after the initial contact. Demographic data, asthma control measures, pulmonary function tests, the number of new prescriptions for oral and inhaled corticosteroids (OCS/ICS) and number of ED visits were collected for the 12 months after the BPA notification. This study followed a prospective cohort design. Chi square test and anova were utilized for the descriptive data, and a non-parametric KWallace test was used on non-normal continuous variables. While a McNemars test was implemented on the paired analysis. Results: The intervention group was significantly more likely to experience passive smoke exposure. There were no significant differences in the day of the week and time of day of the ED visit, number of new OCS/ICS prescriptions, sex, ethnicity, ZIP code, insurance coverage, or age between the intervention and control groups. Face-to-face case management significantly increased the enrollment of subjects in the intervention compared to remote case management. Engagement with case management including asthma specialty care decreased the number of ED visits due to asthma 12 months after the BPA notification. The intervention group was significantly more likely to experience passive smoke exposure. Conclusions: Asthma case management can decrease the number of ED visits in patients with uncontrolled asthma and could improve health care costs. Face-to-face case management is more effective than remote case management in engaging patients. Increased involvement of case management in the ED could improve access to specialty care for chronic disease management.https://digitalcommons.unmc.edu/surp2020/1015/thumbnail.jp