DECREASING THE NEED FOR EMERGENCY ASTHMA CARE IN HARLEM

Morbidity and mortality from asthma have been increasing at an alarming rate in Central Harlem, a predominantly African-American, economically disadvantaged urban community known to have a severe shortage of primary care providers. For the past three years asthma has been the most common diagnosis seen in the Harlem Hospital Center Emergency Department, accounting for 1 in 12 visits. No study has examined the determinants of emergency department (ED) use in this population, thus no information is available about likely areas of intervention to decrease the need for emergency care. Building upon previous work characterizing the population of patients with poorly controlled asthma in this community, the investigators will first identify the factors which are predictors of frequent use of the Harlem Hospital ED by persons with asthma. Using the data thus collected, an intervention strategy designed to deliver asthma patients from our population to a primary care provider, immediately after an emergency visit, will be evaluated for its effectiveness in reducing the need for ED use. Our specific aims are: 1. Develop and establish a surveillance system within the emergency department which will, using an asthma-specific ED chart, monitor all asthma visits by children and adults (equalling approximately 6,500/year) and will collect information on socio-demographic, environmental and clinical factors. Specifically, we plan to: a. Describe the patterns of ED use by asthma patients presenting to Harlem Hospital. b. Define characteristics of the patient which contribute to increased asthma morbidity and mortality. c. Determine areas for intervention likely to decrease the need for frequent ED visits. 2. Develop a team of primary care providers, specially trained in the comprehensive, continuous care of asthma, who will manage patients through all episodes of illness, whether treated as outpatients or inpatients and deliver a patient education program that emphasizes self-regulatory and self-management skills and reduction of environmental allergen and irritant exposure. 3. Evaluate, in a randomized controlled trial, the impact of this specially trained primary care team on frequent users of the ED (three or more visits in one year). We hypothesize that the patients followed by this team will show greater compliance with clinic visits, decreased ED visits, improved self-management practices and improved health status, compared to patients who receive "usual care".