title: Does quality of care affect rates of hospitalization for childhood asthma?
abstract: 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.
authors.affiliation: Children's Hospital, Boston, MA 02115, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Homer
authors.forename: P
authors.initials: P
authors.lastname: Szilagyi
authors.forename: L
authors.initials: L
authors.lastname: Rodewald
authors.forename: S R
authors.initials: SR
authors.lastname: Bloom
authors.forename: P
authors.initials: P
authors.lastname: Greenspan
authors.forename: S
authors.initials: S
authors.lastname: Yazdgerdi
authors.forename: J M
authors.initials: JM
authors.lastname: Leventhal
authors.forename: D
authors.initials: D
authors.lastname: Finkelstein
authors.forename: J M
authors.initials: JM
authors.lastname: Perrin
mesh_terms: 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
chemical_list: D010100:Oxygen