Does quality of care affect rates of hospitalization for childhood asthma?
BACKGROUND
Hospitalization rates for childhood asthma are three times as high in Boston, Massachusetts, as in Rochester, New York; New Haven, Connecticut, rates are intermediate. We undertook this study to determine how care for children admitted for asthma varies across these communities.


METHODS
We performed a community-wide retrospective chart review. We reviewed a random sample of all asthma hospitalizations, from 1988 to 1990, of children 2 to 12 years old living in these communities (n = 614). Abstracted data included demographics, illness severity, and treatment before admission.


RESULTS
Compared with Rochester children, Boston children were less likely to have received maintenance preventive therapy (inhaled corticosteroids or cromolyn [odds ratio (OR), 0.4 (0.2, 0.9)]), acute "rescue" therapy (oral corticosteroids [OR, 0.2 (0.1, 0.4)]), or inhaled beta-agonist therapy [OR, 0.5 (0.3, 1.0)]. A larger proportion of admitted asthmatic patients in Boston (34%) were in the least severely ill group-oxygen saturation 95% or above-compared with patients in Rochester (20%).


CONCLUSIONS
The quality of ambulatory care, including choice of preventive therapies and thresholds for admission, likely plays a key role in determining community hospitalization rates for chronic conditions such as childhood asthma.
Homer
C J
CJ
Children's Hospital, Boston, MA 02115, USA.
Szilagyi
P
P
Rodewald
L
L
Bloom
S R
SR
Greenspan
P
P
Yazdgerdi
S
S
Leventhal
J M
JM
Finkelstein
D
D
Perrin
J M
JM
D000208:Acute Disease; D000553:Ambulatory Care; D001249:Asthma / Q000188:drug therapy / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003237:Connecticut; D003430:Cross-Sectional Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008404:Massachusetts; D008499:Medical Records; D009518:New York; D010100:Oxygen / Q000097:blood; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index
D010100:Oxygen