Dedicated Asthma Center Improves the Quality of Care and Resource Utilization for Pediatric Asthma: A Multicenter Study

Abstract

Abstract. Objectives: To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care. Methods: A retrospective casecontrol design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12-month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample. Results: Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (Ն1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 Ϯ 6.7 days vs 16.6 Ϯ 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 Ϯ 2.8 vs 7.4 Ϯ 4.1; p = 0.03). Conclusions: Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment. Key words: pediatrics; asthma; asthma center; emergency department utilization. ACADEMIC EMERGENCY MEDICINE 2001; 8:709-715 A STHMA is currently the most common chronic condition affecting children in the United States and has been the leading cause of childhood disability over the last 25 years. 1 There are approximately 5 million children in the United States diagnosed as having asthma, 2 and the prevalence of pediatric asthma has increased by approximately 50% over the last decade. Asthma accounts for more than 10 million missed school days annually and an estimated loss of more than $1 billion in productivity by working parents of asthmatic children.3 The direct and indirect monetary costs relating to asthma were estimated to be $11.3 billion in 1998. 4 Hospital visits for pediatric asthma have increased significantly. Over the last decade, asthma admission rates for infants 0-4 years old have nearly doubled, and for school-aged children 5-14 years old, the rate of hospital admission has increased nearly 65%.2,4,5 Additionally, emergency departme...

Emergency department visits for acute asthma by adults who ran out of their inhaled medications

“…30 In addition, our national survey of 177 asthma centers indicated a suboptimal coordination of care between EDs and asthma centers, 31 which is particularly unfortunate given prior studies showing that interventions and treatment by asthma specialists are associated with decreased asthma-related ED visits 32,33 and that dedicated asthma centers have shown promise in reducing ED use. 34,35 Although the ED-to-specialist linkage has not materialized, these prior studies support optimism that adverse asthma outcomes can be prevented and the personal and public health burden can be reduced.…”

Childhood asthma in the emergency department: Trends, challenges, and opportunities

“…ED intervention studies aimed at enhancing chronic asthma management after ED discharge have met with variable results. Referral to asthma care specialists or dedicated asthma care centers reduced symptoms and ED relapses [26,27]. However, innovative intensive management with case managers providing home visits and telephone calls during a 6-month follow-up did not result in significant improvements in asthma management or reduced ED utilization compared to children who received ED education, an asthma care plan, and instructions to follow-up with a PCP [14].…”

Is a family equal to the sum of its parts? Estimating family-level well-being for cost-effectiveness analysis

“…This is because most health interventions are designed to affect individuals, and because clinical and research data are routinely assembled at the level of individual patients. However, physicians, health plan administrators, and policy makers should be concerned about the effects of individual-level health conditions and interventions for these conditions on other family members, caregivers, and significant others [1][2][3]. For example, children of parents with depression are more likely than other children to have mental health problems and use mental health services [4].…”

“…Georgiou [13] reported that a population-based asthma management program significantly reduced adverse utilization, symptoms and restricted activity days for children, and lost workdays for their adult caregivers. Likewise, children who receive proactive care at a dedicated asthma center have fewer emergent health visits and lower school absenteeism, and their parents have fewer lost work days than children who receive care at an emergency department [3].…”