North Carolina medical journal
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Multicenter Study
Improving asthma care in emergency departments: results of a multihospital collaborative quality initiative in rural western North Carolina.
In North Carolina, nearly one-fourth of persons with asthma visit an emergency department (ED) or urgent care center at least once a year because of an exacerbation of asthma symptoms. The Emergency Department Asthma Program was a quality-improvement initiative designed to better understand the population of patients who use the ED for asthma care in rural western North Carolina and to demonstrate whether EDs at small hospitals could, by implementing National Asthma Education and Prevention Program treatment guidelines, improve asthma care and reduce subsequent asthma-related ED visits. ⋯ Many patients who use the ED for care appear to have mild, intermittent asthma and do not identify a regular source of primary care. Efforts to improve asthma care on a communitywide basis and to reduce preventable exacerbations should include care provided in EDs, as this may be the only source of asthma care for many asthma patients. The project demonstrated that regional, collaborative performance improvement efforts in EDs are possible but that many barriers exist to this approach.
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Passage and signing of the Affordable Care Act (ACA) have not ended the debate about the best way to guarantee access to affordable health care. While the debate continues, the responsibilities of US states to implement the provisions of the ACA remain a reality, pending congressional action or court decisions to the contrary.