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Results of an Emergency Department–Based Randomized Clinical Trial

Stephen J. Teach, MD, MPH; Ellen F. Crain, MD, PhD; Deborah M. Quint, BA; Michelle L. Hylan, BA; Jill G. Joseph, MD, PhD

Arch Pediatr Adolesc Med. 2006;160:535-541.

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-diagnosed 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 measure was 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.

Author Affiliations: Division of Emergency Medicine (Dr Teach) and Center for Health Services and Community Research, Children's Research Institute, Children's National Medical Center (Drs Teach and Joseph and Mss Quint and Hylan), George Washington University School of Medicine and Health Sciences (Drs Teach and Joseph), Washington, DC; Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (Dr Crain). Ms Hylan is now with the Genzyme Corporation, Cambridge, Mass. Dr Joseph is now with the University of California at Davis School of Medicine.

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