Clinical Question: Can a multiphasic intervention reduce the rate of readmission among patients with asthma who frequently require health care services?

Setting: Inpatient (any location) with outpatient follow-up

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Hospitalized patients older than 18 years with asthma and at least one hospital admission in the previous year were assigned randomly to usual care (n = 46) or a multiphasic intervention that the authors described as “brief” (n = 50). Group assignment was masked, although the authors do not elaborate on how this was done. The intervention included a nurse-initiated recommendation to simplify or consolidate medications, use of an asthma care flow sheet, patient education, psychosocial support, an individualized asthma management plan, discharge planning, and outpatient follow-up (by telephone, home visits, or primary care physician).

The primary end point, assessed by intention to treat, was readmission because of asthma in the year after enrollment. The researchers also assessed other patient-oriented outcomes such as total readmissions, emergency department visits, quality of life, direct and indirect health care costs, number of days missed from school or work, and cumulative number of days of hospitalization.

In the year after the index hospitalization, patients in the control group had 71 hospitalizations for any cause and 42 for asthma, compared with 31 hospitalizations for any cause and 21 for asthma in the intervention group. In the control group, 46 percent of patients had no readmissions while 60 percent in the intervention group had no readmissions (not significant). Significantly more patients in the control group needed two or more readmissions (33 versus 14 percent). Additionally, the control group had more hospital days (244 versus 82). No significant differences were noted in emergency department visits or visits with health care professionals. Finally, the control group lost 1,040 work or school days compared with 246 days in the intervention group. There were no significant differences in total direct health care expenditures or in quality of life.

Bottom Line: For adults with asthma who have had at least one previous hospitalization, an inpatient multiphasic educational intervention that focuses on improving asthma care and addressing psychosocial support reduces the rate of hospital readmission for all causes and for asthma and reduces school or work absenteeism but has no significant effect on quality of life. (Level of Evidence: 2b)