title: Consistency of care with national guidelines for children with asthma in managed care.
abstract: OBJECTIVE
  To evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines.
  
  
  METHODS
  Cross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity.
  
  
  RESULTS
  Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing.
  
  
  CONCLUSIONS
  There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
authors.forename: G B
authors.initials: GB
authors.lastname: Diette
authors.forename: E A
authors.initials: EA
authors.lastname: Skinner
authors.forename: L E
authors.initials: LE
authors.lastname: Markson
authors.forename: P
authors.initials: P
authors.lastname: Algatt-Bergstrom
authors.forename: T T
authors.initials: TT
authors.lastname: Nguyen
authors.forename: R D
authors.initials: RD
authors.lastname: Clark
authors.forename: A W
authors.initials: AW
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards* / Q000706:statistics & numerical data; D015146:Midwestern United States; D020380:Needs Assessment / Q000458:organization & administration; D009511:New England; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000193:education / Q000523:psychology; D010353:Patient Education as Topic / Q000592:standards; D010372:Pediatrics / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000458:organization & administration