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P Parks

Publications and source records attributed to P Parks.

At least 19 recordsLinked to original sources
PubMed1999

A randomized controlled trial of a pediatric asthma outreach program.

BACKGROUND: Previous studies have shown that asthma education and case management may reduce asthma emergency care, hospitalizations, and expenditures. OBJECTIVE: We sought to study the effect of an asthma outreach program (AOP), a team-based, case-management intervention, on emergency ward (EW) and hospital use. METHODS: Fifty-seven patients aged 1 to 15 years with the diagnosis of asthma based on the usual clinical practice criteria who were continuously enrolled in a staff-model health maintenance organization for a period of at least 2 consecutive years were randomized into 2 intervention groups. The control group received a single intensive asthma education intervention, and the AOP group received the same initial education but then was followed-up by an asthma case management nurse throughout the intervention period. RESULTS: EW visits, hospitalizations, and total outside-of-health-plan expenditures (consisting of EW and hospital expenses, as well as miscellaneous costs, such as ambulance, durable medical equipment, tertiary referrals, and home care) were assessed from claims filed for a year before and after enrollment. Control group patients experienced significant reductions in EW visits (39%), hospitalizations (43%), and outside-of-health-plan costs (28%), possibly as a result of the baseline educational intervention received by all enrolled patients, in conjunction with regression to the mean. AOP group patients experienced significant reductions in EW visits, (73%, P =.0002), hospitalizations (84%, P =.0012), and outside-of-health-plan use (82%, P <.0001). When compared with the control group, AOP group patients demonstrated additional significant reductions in EW visits (57%, P <.05), hospitalizations (75%, P <.05), and outside-of-health-plan use (71%, P <.001). Estimates of direct savings to the health plan ranged from $7.69 to $11.67 for every dollar spent on the AOP nurse's salary, depending on assumptions. CONCLUSIONS: Asthma patients in a staff-model health maintenance organization decreased their resource use between 57% to 75% by participation in an AOP as compared with a randomized control group receiving only an educational intervention. Substantial savings were achieved compared with the cost of the AOP nurse.

Adolescent↗
PubMed1998

Outcomes for control patients referred to a pediatric asthma outreach program: an example of the Hawthorne effect.

A study was designed to determine whether identification of high risk for exacerbations of asthma based on pediatrician concern, emergency department visits, or hospital stays results in a decrease of resource utilization because of referral to an asthma outreach program even if the intervention does not take place. The findings for such a group were compared with those for a group who did undergo intervention with an asthma outreach program. Fifty-six patients 1 to 14 years of age were assigned to one of two groups. The control group (those who did not undergo intervention) had consistent but not statistically significant reductions in utilization of emergency visits, hospitalizations, and dollars spent (21%, 24%, and 32%, respectively). The group who underwent intervention with the asthma outreach program had large and statistically significant decreases in the same parameters (emergency visits, 60%, P = 0.001; hospital stays, 74%, P = 0.008; dollars spent, 72%, P = 0.004). However, the apparently insignificant effect of the reductions in utilization by the control group substantially altered interpretation of the outcomes of the study. Cost savings were reduced from $11.69 per dollar spent on intervention to $6.49 per dollar spent. In before-and-after studies such as those typically conducted during continuous quality improvement projects, which typically do not have control groups, investigators need to consider control group effects when they assess the results of intervention.

Adolescent↗
PubMed1995

Reduction in resource utilization by an asthma outreach program.

OBJECTIVE: To study the effect of an asthma outreach program on emergency ward and hospital utilization. DESIGN: Before and after trial. SETTING: Ambulatory patients in a staff-model health maintenance organization with a 70% black inner-city population. PATIENTS: Fifty-three patients aged 1 to 17 years with the diagnosis of asthma based on usual clinical practice criteria. INTERVENTION: Asthma emergency ward visits and hospitalizations were monitored over a 6-month to 2-year period after enrollment in the program. Patients were scheduled for one-on-one orientation visits with the asthma outreach nurse and instructed in asthma management, medications, triggers, and use of inhalers and peak flowmeters. An individualized step-care treatment program was outlined for each patient by the nurse, primary care pediatrician, and, when appropriate, an allergist. The outreach nurse maintained personal or telephone contact with the families on a regular basis to assure understanding of and compliance with the treatment plan. OUTCOME MEASURES: Outcome was assessed by measuring annualized emergency ward and hospital admissions for each patient for an equal period before and after entry into the program. RESULTS: Emergency ward admissions were reduced 79% (from a rate of 72 visits per year to 15 visits per year, P < .0001) and hospital admissions were reduced 86% (from 35 per year to five per year, P < .001). These reductions were achieved by a single outreach nurse working an average of 8 hours per week at an annualized cost of $11,115; this saved approximately $87,000 in costs. CONCLUSIONS: Patients enrolled in a pediatric asthma outreach program experienced a significant reduction in utilization of emergency ward and hospital admissions, resulting in reduced cost of care.

Adolescent↗
PubMed1995

Practice expense studies.

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Centers for Medicare and Medicaid Services, U.S.↗