An economic evaluation of short-term inpatient rehabilitation for children with severe asthma.
ABSTRACT The cost of asthma care in the United States in 1990 has been estimated to be 6.2 billion dollars. The greatest proportion is due to hospital care.
We report changes in estimated medical charges of 59 children with severe asthma 1 year before inpatient rehabilitation and over a 4-year follow-up period.
Asthma resource use (e.g., hospital, physician, medication) was identified before and after inpatient rehabilitation. Estimated charges were assigned. This was done retrospectively for the 1-year period before rehabilitation, prospectively during rehabilitation, and over a 4-year follow-up period. Patients served as their own controls. There was no control group.
When median asthma resource use 1 year before rehabilitation was compared with that during the first, second, third, and fourth years of follow-up, there was a reduction in median hospitalization and median emergency care. Compared with mean total medical charges the year before rehabilitation, reductions in mean total medical charges were 56.7% at the completion of the first year (excluding charges for rehabilitation), 70.5% at second year, 74.6% at third year, and 77.5% at fourth year. Over the 4-year postrehabilitation period, the discounted cumulative net savings was $29,605. The discounted cumulative net savings surpassed the mean rehabilitation charge during the early months of the fourth year of the postrehabilitation period.
Inpatient rehabilitation was significantly associated with a reduction in estimated total medical charges over a 4-year follow-up period.
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ABSTRACT: Optimal control of asthma has yet to be achieved globally, as costs of care continue to mount, patient quality of life remains inadequate and mortality rates are unacceptably high. While prevalence rates are rising, asthma continues to be under-diagnosed and under-treated. Because of disease heterogeneity, it is difficult to determine the type and dose of medication that will afford patients the best risk/benefit ratio and to determine which patients will or will not develop irreversible airflow limitation. Poor patient compliance/adherence can negatively impact outcomes and must also be assessed. While inflammation is an essential component of asthma, current practice parameters do not include its measurement in the diagnosis or management of disease. Studies employing surrogate markers of inflammation to orchestrate therapy, including induced sputum for eosinophils and methacholine sensitivity, a measure of airways hyper-reactivity, have revealed improved asthma outcomes. While these studies are less invasive than the direct assessment of inflammation with bronchial biopsy and/or evaluation of BAL washings, they are still time consuming and labor intensive and impractical for routine asthma management. Inducible nitric oxide synthase (iNOS) is produced predominantly by airway epithelial cells and is up-regulated as part of the inflammatory process resulting in elevated levels of fractional exhaled nitric oxide (FENO) in patients with asthma. As there is a positive correlation between airway hyper-reactivity, sputum eosinophilia and FENO, this surrogate marker of eosinophilic inflammation, which is non-invasive and is quickly and easily measured, has significant potential as an “inflammometer” in the management of asthma. Despite some controversy, studies indicate that the evaluation of FENO, which is more sensitive, but correlates poorly with pulmonary function, should prove to be a valuable adjunct to current guideline recommendations. Although further studies are needed to understand the scope and potential impact of measuring FENO, it appears to fulfill an unmet need by providing a simple, non-invasive well-tolerated, standardized and reproducible test that is a surrogate measure of eosinophilic airway inflammation in patients with asthma. When used to complement standard monitoring tools, improved asthma outcomes appear likely.12/2008: pages 81-100;
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ABSTRACT: Expert Panel Report 3 Guidelines recommend that physicians use adherence management strategies; however, the evidence for these interventions is weak. Clinicians need effective proven adherence interventions, because approximately 50% of patients with asthma do not follow physician medication recommendations, resulting in unnecessary morbidity. This review examines components of an organized adherence management program that has been successful in uncontrolled trials promoting adherence and reducing morbidity and cost. Literature review was undertaken in the following areas of asthma management: guidelines, cost; morbidity; adherence, monitoring; and communication skills. Studies that examined outcomes from psychoeducational, behavioral, monitoring, and communication interventions. Studies using individual interventions by themselves were modestly effective in promoting adherence. Two uncontrolled studies of children with severe asthma, treated in both inpatient and outpatient rehabilitation settings, used 4 intervention strategies to achieve marked reduction in morbidity and cost. These strategies included: (1) objective adherence monitoring; (2) identification of the cause(s) of nonadherence; (3) delivery of specific strategies for each cause; and (4) use of motivational interviewing communication skills to enhance the delivery of the strategy. Nonadherence continues to be a significant problem. Physicians need a proven organized approach to improve adherence and reduce morbidity and cost. Evaluation of effective methods in a controlled fashion is warranted to increase adherence management evidence for future asthma guidelines.Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 04/2011; 106(4):283-91. · 3.45 Impact Factor
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ABSTRACT: Endotoxins and allergens represent the major relevant contents of the atmospheric bioaerosol with regard to the triggering and exacerbation of allergic diseases. In this study, mattress concentrations of endotoxin and indoor allergens were measured in three hospitals in the alpine climate of Bavaria and in adjacent homes. Dust was collected from each of 10 mattresses according to a standardized protocol, and endotoxin was analyzed with the Limulus Amebocyte Lysate (LAL) test, indoor allergens Der p 1, Der f 1 and Fel d 1 were analyzed by ELISAs. The concentration of endotoxin in the mattresses did not differ significantly between different cities. The percentiles of endotoxin were significantly higher in hospitals than in homes. The concentrations of mite allergens (Der p 1 and Der f 1) in the dust were significantly lower in all hospitals than in homes. There was no significant difference of mite allergens between different time points. The concentrations of Fel d 1 were significantly higher in the autumn than in the summer (median: 1376 vs. 478ng/g). No significant differences of Fel d 1 were found between hospitals and homes or between different hospitals. As Fel d 1 concentrations reached levels at which cat allergic patients can experience symptoms, efforts had to be made to reduce the concentrations of Fel d 1 especially in hospitals. In contrast, mite allergens were low in hospitals, which can be clinically beneficial for patients with mite allergies.International Journal of Hygiene and Environmental Health 01/2008; 212(1):21-6. · 3.05 Impact Factor