Evaluating a Multidisciplinary Approach for the Management of Severe Asthma in the New York City Borough of the Bronx: The Montefiore Asthma Center Experience
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Ryan Abraham, Jalpa Patel, David Cobden, Sunit P. Jariwala, MD
RATIONALE: The Bronx bears the heaviest asthma burden of all New York State counties. The Montefiore Asthma Center (MAC) is a team-based approach that evaluates and treats adults and children in the Bronx. This study evaluates if MAC patients experienced improvements in asthma utilization compared to patients that received primary care provider (PCP)-based asthma care.

METHODS: Through our institution’s EMR, we identified patients with physician-diagnosed asthma and with an asthma ED visit and/or hospitalization in the year before the initial (‘index’) outpatient asthma visit. Patients evaluated at the MAC were ‘cases’ and non-MAC patients were ‘controls’. MAC cases received multidisciplinary care (joint management by Allergists, Pulmonologists, and an asthma educator), while controls received PCP-based asthma management and nurse-delivered remote outreach (three monthly asthma education phone calls). We performed exact matching between the cases and controls per the numbers of asthma ED visits and hospitalizations in the year before the index visit, and compared asthma utilization in the 1 year before and after the index visit.

RESULTS: Patient identification and matching yielded 55 MAC and 55 controls, including 43 children and 12 adults in each group. The MAC resulted in significant decreases (-53.8%, p=0.03) in asthma hospitalizations, and significant increases (5.4%, p=0.01) in asthma office visits. The MAC and control groups were similarly impacted regarding asthma ED visits.

CONCLUSIONS: The MAC was successful in reducing asthma hospitalizations, although remote nursing support combined with PCP-based care can positively impact asthma utilization. Larger randomized studies are necessary to further evaluate these findings.