Consistency of care with national guidelines for children with asthma in managed care.
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.
Diette
G B
GB
Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
Skinner
E A
EA
Markson
L E
LE
Algatt-Bergstrom
P
P
Nguyen
T T
TT
Clark
R D
RD
Wu
A W
AW
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