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From 40 ER visits to zero in one year: coordinated care makes the difference for asthma

Coordinated care helps St. Clair Davis manage his asthma

March 26, 2012 - A few years ago, St. Clair Davis was going by ambulance to hospital emergency rooms so often that a social worker from Multnomah County Emergency Medical Services complained about the cost.

Davis, in his late 20s, had several health problems, including asthma. He had trouble managing his prescriptions, and without carefully directed use of his medications, his health went haywire. Frightening asthma attacks repeatedly sent him to the hospital.

"I didn't like that I had to go there," Davis says. "But I couldn't breathe, and I'd get scared, so I'd call 911."

Davis also has schizophrenia and cognitive challenges, and a history of alcohol abuse.

In 2009, he showed up at hospital emergency rooms 40 times for asthma attacks and was also hospitalized twice for psychiatric problems — at an estimated total cost of $97,800. The next year, he started getting coordinated primary care from a team at Central City Concern.

But Davis, now 30, made zero trips to the hospital last year. The cost of his primary care at the clinic and occasional home visits totaled $11,897 for the year — nearly a 90 percent drop from two years ago.

Davis takes a TriMet bus to the Central City Concern clinic six mornings a week. He gets a quick checkup, along with his medications, and breathes for 15 minutes through a nebulizer tube, which helps open his lung passages. But he also learns the importance of keeping to a routine and taking responsibility for his own health. He interacts with familiar caregivers and fellow clients. He picks up a small daily payout of his disability check — about $10 — to guarantee that he doesn't lose the entire check or use it inappropriately.

"The incentive and routine worked for him, and for us, and he has remained consistent ever since," says Vicki Zeitner, Davis's case manager.

If he does not show up for his daily appointment — which rarely happens — a member of the care team visits his apartment to check on him.

Davis has not been to a hospital emergency department since October 2010 — which his physician assistant calls "an amazing accomplishment."