Consistency of care with national guidelines for children with asthma in managed care

Diette, Gregory B.; Skinner, Elizabeth A.; Markson, Leona E.; Algatt-Bergstrom, Pamela; Nguyen, Theresa T. H.; Clark, Rebecca; Wu, Albert W.

doi:10.1067/mpd.2001.109600

Cited by 109 publications

(68 citation statements)

References 11 publications

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“…Even after 2 weeks, less than half of the study subjects had either completed or made an appointment with their regular asthma care provider. These disappointing follow-up results again are similar to those reported previously [18][19][20][21][22] and occurred despite considerable efforts on behalf of the ED staff to facilitate such follow-up visits; these efforts included informing the accompanying adult to make a follow-up appointment, faxing a copy of the dictated medical chart to the regular asthma care provider, and identifying a medical provider and making an immediate referral for the minority of patients who did not have a PCP.…”

Section: Discussionsupporting

confidence: 59%

“…9,10,15,16,18 For example, many children who use the ED seem to be undermedicated in terms of using an inhaled corticosteroid (ICS) or other long-term control medication, 8,10,11,16,17 and follow-up visits with a primary care provider (PCP) usually occur much later than the time frame recommended in the NAEPP guidelines. [19][20][21][22] Here we describe the characteristics of children treated for an acute asthma exacerbation in 3 EDs in western Michigan (selected to represent urban, suburban, and rural settings) and report on several quality indicators of care and management based on NAEPP guidelines. …”

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confidence: 99%

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Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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OBJECTIVES. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting.METHODS. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines.RESULTS. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider.Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas ϳ2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.A STHMA IS ONE of the more common reasons for children's visits to emergency departments (EDs). 1-3 National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. 4,5 The number of ED visits for asthma in children Յ14 years of age increased ϳ14% in the Un...

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Section: Discussionsupporting

confidence: 59%

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confidence: 99%

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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“…9-11 For children with chronic conditions, such as asthma or diabetes, continuous coverage is critical to ensure compliance with care regimens. 12,13 Despite recent efforts to expand and simplify insurance enrollment procedures, ~8.2 million children, or 12% of all children, were without health insurance coverage at some point in 2003. 14 For children in low-income families, the separation of eligibility and enrollment in Medicaid from public cash assistance (known as Temporary Assistance to Needy Families [TANF]) in 1996 was followed by declines in Medicaid enrollment likely as a result of confusion about eligibility and enrollment.…”

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confidence: 99%

Insurance Gaps Among Vulnerable Children in the United States, 1999–2001

Satchell

Pati

2005

Pediatrics

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Objective-To quantify the number of children who experience gaps in insurance coverage and to determine whether vulnerable subgroups of children experience noteworthy lapses in insurance coverage. Vulnerable subgroups of children included children with chronic conditions, those from ethnic/racial minorities, and those living in poverty. On the basis of cumulative annual monthly insurance coverage status, each child fell into 1 of 3 groups: continuous coverage, uninsured, or gaps in coverage. Using SAS-callable SUDAAN, we conducted multivariate ordinal logistic regression model to quantify the likelihood of having gaps in coverage for vulnerable subgroups of children. Methods-WeResults-From 1999 to 2001, we found that > 9 million American children annually had gaps in coverage and that 5 to 6 million children annually were uninsured for the entire year. Sixty percent of children experienced gaps of at least 4 months, and > 40% of all publicly and privately insured children had coverage gaps. After accounting for relevant covariates, children with chronic conditions were just as likely as other children to have gaps in coverage or be uninsured; Hispanic children were most likely to have insurance gaps or be uninsured; and children from poor and nearpoor families were 4 to 5 times more likely to have lapsed coverage than children from high-income families. Poverty and maternal education were the strongest factors associated with lapsed coverage.Conclusions-Unstable health insurance is an underrecognized problem for children, including those with chronic conditions. Because unstable insurance coverage can lead to inadequate health care utilization and poor child health outcomes, strategies to promote stable insurance coverage merit serious consideration. Creating a stable insurance coverage system for American children has been one of the most persistent and intractable challenges in health policy. Previous studies have documented that uninsured children are less likely to use medical services, less likely to use preventive services, and less likely to have a usual source of care. 1-6 Cross-sectional studies of uninsured children likely capture some children who experience short-term gaps in coverage as well as those who are ineligible for any coverage within the current system. Unlike ineligible children, it is likely that children with short-term gaps in coverage are eligible for insurance but not enrolled, and there may be opportunities to simplify the current system of enrollment and renewal to prevent these lapses in coverage. Because gaps in coverage can disrupt patient-provider relationships and affect appropriate utilization for children during critical periods of growth and development, 7,8 maintaining stable coverage is an important priority. Many childhood and adolescent problems, such as developmental delays, risk-taking behaviors, and nutritional concerns, require regular supervision for early identification and optimal treatment. 9-11 For children with chronic conditions, such as asthma or diab...

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“…15,16 Studies conducted in the Bronx, New York, and Baltimore, Maryland, have each estimated that approximately 55% of children with moderate-to-severe persistent symptoms are not using daily anti-inflammatory medications. 15,17 A study of asthmatic children receiving Medicaid insurance in Connecticut identified a similar percentage. 18 Although these studies did not distinguish between issues related to physician practice pattern and family medication adherence, other authors have documented several barriers to physician adherence to the practice guidelines.…”

Section: Discussionmentioning

confidence: 89%

Identification of Gaps in the Diagnosis and Treatment of Childhood Asthma Using a Community-based Participatory Research Approach

Lewis

Robins

Joseph

et al. 2004

Journal of Urban Health: Bulletin of the New York Academy of Me

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Consistency of care with national guidelines for children with asthma in managed care

Cited by 109 publications

References 11 publications

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Insurance Gaps Among Vulnerable Children in the United States, 1999–2001

Identification of Gaps in the Diagnosis and Treatment of Childhood Asthma Using a Community-based Participatory Research Approach

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