ORLANDO – A chart notation of "lost to follow-up" can mean loss of life for children with severe asthma, suggest the results of a retrospective study reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Of 14 children who died from asthma at a children’s hospital over a 10-year period, 11 (79%) evidently never received follow-up care in the asthma clinic, despite having prior asthma-related hospitalizations and clinic appointments made at the time of discharge, reported Dr. Sahar Faghih, a second-year fellow in allergy and immunology at Children’s Hospital of Michigan in Detroit.
"Deaths of high-risk asthmatics were decreased by a combination of a multidisciplinary team clinic and a social service liaison for increased family support. This further emphasizes that barriers to care and clinic attendance necessitate further attention," Dr. Faghih and her colleagues wrote in a poster.
The investigators reviewed a decade of charts on children aged 1-18 years who died from asthma in the period spanning 3 years before to 7 years after the multidisciplinary Children’s Hospital Asthma Management Program (CHAMP) clinic opened in 2004. The social service component of the multidisciplinary team was phased out after 3 years due to lack of funding.
"Deaths of high-risk asthmatics were decreased by a combination of a multi-disciplinary team clinic and a social service liaison for increased family support."
Five of the 14 deaths occurred before the CHAMP clinic model was implemented, and none of these children were enrolled in a health plan. No deaths occurred during the 3 years that a social worker was present in the clinic.
"With the children who died in the care of the asthma clinic, there were some issues of adherence, and two out of five deaths that occurred between 2007 and 2010 occurred in patients who were previously enrolled in CHAMP. Both of those children had a history of medical neglect cases on file with the state," Dr. Faghih said in an interview.
"Perhaps if this clinic still had in place the social service intervention, we may have been able to prevent those deaths from happening," she added.
Although the multidisciplinary model was developed in a specialty children’s hospital, it can be replicated in community practices. Other studies have shown that programs coordinated by trained clinical nurses or nurse practitioners that include asthma education, emphasis on adherence, home visits, and telephone contacts can reduce asthma hospitalizations and emergency department visits by 71%-85%, Dr. Faghih said.
Team-based asthma education and case management programs can save money as well as lives, the investigators noted. They cited a randomized study showing that such programs reduced emergency department visits by 57%, hospitalizations by 75%, and expenditures by 71%. The same study estimated that for every dollar spent on a dedicated asthma nurse, $7.69-$11.76 was saved (J. Allergy Clin. Immunol. 1999;103:436-40).
"Based on 2008 CDC [Centers for Disease Control and Prevention] reporting, there have been a total of 200 pediatric asthma deaths. Perhaps, with the implementation of a multiteam approach, this number can be rectified," Dr. Faghih and her colleagues wrote.
The study was internally funded. The authors reported that they had no conflicts of interest.