for patients pre- and postenrollment.
The cost difference between clinic
and nonclinic patients from 2010 to
2011 was calculated to be $111,000
annually (data not shown). The median length of the hospital stay for
clinic and nonclinic patients was
2 days (range, 1-10 and 1-7 days, respectively). The national average was
4. 3 days.
From 2008 to 2009, there were
123 ED visits and 20 hospital admissions related to asthma of patients who would later be enrolled
in the asthma clinic study. From
2010 to 2011 there were 31 ED visits and 8 hospital asthma admissions
(Table 4). These data were used to
determine the potential cost savings
for the clinic (Table 5). Based on current reductions, the potential annual
cost savings was $85,405 if all adult
asthma patients were seen in the
pharmacy managed clinic (Table 6).
Level of Control
A total of 66 patients had 3 or more
visits to the asthma clinic. Of these
patients, 30% had no change in control, 60% showed some measure of
improvement, and 11% had a decrease in control based on the national guidelines (Table 7).
At each visit, the patient’s current perception of asthma control, satisfaction
with control, and clinic grade related
to asthma care was determined. Of
the 66 patients with 3 or more visits,
a large portion of the questionnaires
were missing when the data were collected. Table 8 shows the results of
the data for patients with 3 more visits and 2 completed forms from different visits. These data points may
not have been from the first or most
From earliest to most recent visit,
patient perception of asthma control
compared with clinical guidelines im-
proved moderately. Sixteen patients
had a clinical improvement from VPC
to NWC with 13 (81%) believing
their symptoms were now WC.
The results of this performance improvement evaluation are encouraging. However, not all positive data
may be directly attributed to the
asthma clinic. The statistical analysis for this study does not seek to
remove confounding variables.
Without removing potential confounding variables, questions remain
about the accuracy of the outcome.
However, combining the statistical
data in Table 3 and the 2-year comparative data in Table 4, strong evidence exists that a positive impact
from the clinic had occurred even in
the presence of potential confounding variables.
The financial impact of asthma
was evident with the 2010 to 2011
cost for ED visits and hospital admissions at $265,928. Asthma clinic patients made up only 8% ($21,155) of
this cost and yielded an annual cost
savings of $24,352. Obviously, the
8% was a direct result of the number
of nonclinic vs clinic patients. However, the cost savings of $24,352 was
Table 6. Potential Cost Savings
ED 75 428 159,644 119,733
Hospital 60 71 85,129 51,077
2-Year Total 170,810
Annual Potential Savings 85,405
ED = emergency department.
Table 7. Change in Level of Control Based on Guideline Criteria
Number Total %
WC-WC 9 13. 6
NWC-NWC 1 1.5
VPC-VPC 10 15. 2
VPC-NWC 16 24. 2
VPC-WC 15 22. 7
NWC-WC 8 12.1
WC-NWC 3 4. 5
WC-VPC 0 0.0
NWC-VPC 4 6.1
NWC = not well controlled; WC = well controlled; VPC = very poorly controlled.