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Adaptation of an Asthma Management Program to a Small Clinic
Kenny Yat-Choi Kwong, MD; Nasser Redjal, MD; Lyne Scott, MD; Marilyn Li, MD; Salima Thobani, MD; and Brian Yang, MS
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Adaptation of an Asthma Management Program to a Small Clinic

Kenny Yat-Choi Kwong, MD; Nasser Redjal, MD; Lyne Scott, MD; Marilyn Li, MD; Salima Thobani, MD; and Brian Yang, MS
The authors adapted a successful large-scale, specialist-run asthma management program to an existing multi-specialty clinic utilizing existing resources and achieving similar outcomes.
The results of this study must be interpreted with caution. Our asthma clinic was set up with direct input from, and collaboration with, a well-established and successful disease management program. Further, there were ongoing consultations and clinical decision making guidance from asthma specialists. Systems without such supervision may not achieve similar results. The stationary clinic enrolled patients for a shorter timeframe before outcomes analyses were performed compared with 6 years of reported Breathmobile/PADMAP program data.5 Patients are likely more compliant during their initial engagement; therefore achieving better disease control initially, before gradually losing control in the ensuing years, may be an important contributing factor. Our patient census was lower, which enabled more personalized treatment and education per patient. We had a slightly lower operating cost per half day of operation compared with the Breathmobile system. However, the HUMC clinic only operated 1 half day per week compared with the 5 full days of the Breathmobiles. It is unknown whether operating costs would increase to become commensurate with those of the Breathmobiles if our asthma clinic was expanded in terms of treatment hours.

 In regard to patient outcomes, patients served as their own historical controls (for improvements in asthma control and healthcare utilization). We did not follow a control cohort as this was a real-world clinical treatment study. Regression to the mean is a significant problem with this research design, and may have had a significant impact on our results, making them less likely to generalize to other populations. Finally, there may be confounding variables in our analysis, specifically, time-to-achieve control, as we did not control for previous asthma utilization and adherence.

CONCLUSIONS

A large-scale, successful mobile asthma disease management system can be adapted to a stationary multi-specialty clinic system on a sustainable part-time basis and achieve similar asthma-related health outcomes.

Acknowledgments

The authors wish to thank the staff of the HUMC/MFI clinic and the Breathmobile/PADMAP asthma disease management system for assistance with this study. Sarah Staples, MA, ELS, assisted with manuscript preparation.

Author Affiliations: Los Angeles County+University of Southern California Medical Center, Division of Allergy-Immunology (KYK, LS, ML, ST), Los Angeles, CA; Harbor-UCLA Medical Center, Division of Allergy-Immunology (NR), Torrance, CA; Thermo-Fisher Scientific (BY), Waltham, MA.

Source of Funding: The study was funded in large part by Thermo-Fisher Scientific.

Author Disclosures: Dr Kwong is a member of the Serving Underserved nonprofit and supports the Breathmobile program; he also has served as a consultant for Thermo-Fisher Scientific, which funds (in part) this study. Dr Li is the president of the Los Angeles Society of Allergy, Asthma & Clinical Immunology, Inc, on the board of the Cuban Society of Allergy, Asthma and Clinical Immunology, and has previously served as a consultant and received lecture fees from MEDA, but reports no conflicts of interest. Mr Yang is an empoyee of Thermo-Fisher Scientific, which manufactures in vitro sIgE assays. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (KYK, NR, LS, BY, ST); acquisition of data (KYK, LS); analysis and interpretation of data (KYK, NR, LS, BY, ST); drafting of the manuscript (KYK, NR, BY, ST); critical revision of the manuscript for important intellectual content (KYK, ML, NR, LS, BY, ST); statistical analysis (KYK, ML, LS); provision of patients or study materials (KYK), LS); obtaining funding (KYK, BY); administrative, technical, or logistic support (KYK, ML); and supervision (KYK).

Address Correspondence to: Kenny Yat-Choi Kwong, MD, Los Angeles County+University of Southern California Medical Center, Division of Allergy-Immunology, Department of Pediatrics, 1801 East Marengo St, Rm 1G1, Los Angeles, CA 90033. E-mail: kkwongusc@yahoo.com. 
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