Improving preventive care in high risk children with asthma: lessons learned

Butz, Arlene; Halterman, Jill S.; Bellin, Melissa H.; Kub, Joan; Tsoukleris, Mona; Frick, Kevin D.; Thompson, Richard E.; Land, Cassia; Bollinger, Mary E.

doi:10.3109/02770903.2014.892608

Cited by 15 publications

(17 citation statements)

References 30 publications

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“…As previously reported, caregivers were primarily the biological mother (n=276, 92.3%) and single (n=210, 70.7%) (Authors, 2014b). A majority had completed high-school education/received their GED (n=117, 39.1%) or attended some college or trade school (n=81, 27.1%) (Table 1).…”

Section: Resultssupporting

confidence: 59%

“…This sub-analysis is part of a larger randomized controlled trial that tested the effectiveness of a behavioral/educational intervention in families of children with poorly controlled asthma (Authros, 2012, 2014b). After obtaining institutional review board approval, caregivers of 300 inner-city children with asthma aged 3-10 years were recruited from two major urban hospitals after the child was discharged from a Pediatric ED.…”

Section: Methodsmentioning

confidence: 99%

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Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis

Bellin¹,

Osteen²,

Kub³

et al. 2015

Journal of Pediatric Health Care

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Introduction The intent of this analysis was to examine the longitudinal effects of risk and protective factors on quality of life (QOL) in caregivers of minority children with asthma. Method Caregivers (n=300) reported on demographics, child asthma characteristics, daily asthma caregiving stress, general life stress, social support and QOL. Latent growth curve modeling examined changes in QOL across 12 months as a function of stress, asthma control, and social support. Results Caregivers were primarily the biological mother (92%), single (71%), unemployed (55%), and living in poverty. Children were African American (96%), Medicaid eligible (92%), and had poorly controlled asthma (93%). Lower QOL was associated with higher life stress, greater asthma caregiving stress, and lower asthma control over time. Discussion Findings underscore the importance of assessing objective and subjective measures of asthma burden and daily life stress in clinical encounters with urban, low-income caregivers of children with poorly controlled asthma.

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Section: Resultssupporting

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis

Bellin¹,

Osteen²,

Kub³

et al. 2015

Journal of Pediatric Health Care

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“…[5][6][7][8] Multiple quality improvement (QI) efforts to improve inpatient asthma care for children have been reported, but a positive impact on asthma outcomes is often not demonstrated. 3,[9][10][11][12][13][14][15][16][17][18] No data exist about the sustainability or long-term impact of QI interventions. Furthermore, most of the successful pediatric inpatient asthma interventions are implemented at a tertiary care pediatric centers, with little information available about dissemination to community hospitals.…”

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confidence: 99%

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

et al. 2015

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BACKGROUND AND OBJECTIVES: Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals.METHODS: Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses.RESULTS: At PCH, the CS increased and remained at .90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P = .026) and length of stay (P , .001), a trend toward reduced costs (P = .094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting .2 years after dissemination, with a slight but not significant readmission reduction (P = .119), a significant reduction in length of stay (P , .001) and cost (P = .053), a slight increase in hospital resource use (P = .032), and no change in ICU transfers or deaths.CONCLUSIONS: Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.

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“…28 Other reports are limited to children and use only preprogram and postprogram comparisons. 36,[64][65][66][67][68][69][70][71][72][73] Ragazzi et al 36 were able to improve 4 of 8 care processes, but in exit interviews, staff reported those improvements were unlikely to be sustained without ongoing external support. Adding nurse managers, plus "intense interaction" with families and home visits, both Woods et al 72 and Lob et al 69 demonstrated a pre-to-post decrease in rates of asthma ED visits (68% and 70%, respectively), whereas Bunik et al 64 and Vernacchio et al 68 used similar methods but found no improved outcomes, with improvement only in documentation of care processes.…”

Section: Discussionmentioning

confidence: 99%

Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

et al. 2018

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PURPOSE The purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices. METHODSWe used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines. RESULTSWe enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with "in control" asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year (P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).CONCLUSIONS Introduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices' adherence to asthma management guidelines. Ann Fam Med 2018;16:100-110. https://doi.org/10.1370/afm.2179. INTRODUCTIONA sthma is a common chronic condition, [1][2][3] and primary care is the site of most asthma diagnoses and management.2-5 Implementation of asthma guidelines has been challenging, and the burden of asthma remains high with little improvement from 1990 to 2010. [6][7][8][9][10][11][12][13] Use of a metric for assessing asthma control has been suggested for improving asthma care, and several asthma control scores have been developed and validated against allergists' assessments.14-25 But use of these tools remains limited and has not significantly improved asthma outcomes. 23,[26][27][28][29][30][31][32][33][34][35][36] The Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) (Figure 1) tools were developed not only to provide a score for asthma control, but also to guide further evaluation of inadequate control with a link to a care algorithm (Supplemental Figure 1, available at http://www.annfammed.org/content/16/2/100/suppl/ DC1/). In a small pilot study, use of the Asthma APGAR tools was associated with enhanced asthma guidelines adherence, and focus groups of patients an...

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Improving preventive care in high risk children with asthma: lessons learned

Cited by 15 publications

References 30 publications

Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis

Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

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