Asthma is a widespread disease. There are 500,000 asthma hospitalizations each year. There were 474,000 hospital discharges in 1996 with asthma as the first diagnosis, which resulted in 1.7 million hospitalized bed days. [4) Asthma is the seventh most common diagnosis-related group in hospitals in the US.[4) In one year alone, hospitalizations for asthma increased by 50,000 (12.5%) from 400,000 to 450,000 (from 1986 to 1987). [6) For the emergency department (ED) there are almost 2 million ED visits for asthma each year, which represents about 2% of all ED visits) In 1995, asthma accounted for 1.9 million ED visits, or 1.9% of all ED visits in the United States.[l) [Si) [±] [d) Asthma accounts for 6.3 million office visits (1 %) each year.m The present investigation is a Longitudinal Prospective Study that was set forth five years ago through the Emergency Services Clinical Quality Improvement Team (E.S.C.Q.I.) at St. Luke's Hospital. The ESCQI team put together a pilot program to reduce repeat asthma visits to the ED through education, treatment and follow up with primary care. St. Luke's Hospital is located in New Bedford, Massachusetts and is know as the largest community hospital in the state. The institution is a 360-bed hospital that has had over: 70,000 visits to their emergency-department. The goals are to improve asthma disease management through direct patient education, and follow up with utilization of the visiting nurse association (V.N.A.). The asthma project involved the provisions of an asthma education packet, peak flow meters, and a referral to the VNA for follow up education, environmental survey and primary care linkage. The emergency department respiratory therapy and nursing teams utilized a reusable peak flow meter and metered dose inhaler spacer for patient education. V.N.A. would follow up the initial ED education in the home. Patient return ED visits are then monitored for a 90-day period.
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