Dedicated asthma center improves the quality of care and resource utilization for pediatric asthma: a multicenter study.
OBJECTIVE
To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care.


METHODS
A retrospective case-control design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12-month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample.


RESULTS
Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (> or = 1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 +/- 6.7 days vs 16.6 +/- 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 +/- 2.8 vs 7.4 +/- 4.1; p = 0.03).


CONCLUSIONS
Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment.
Battleman
D S
DS
Office of Outcomes Research, Department of Public Health, New York Presbyterian Healthcare System, Weill Medical College of Cornell University, New York, NY 10021, USA. dsbattle@med.cornelle.edu
Callahan
M A
MA
Silber
S
S
Muñoz
C I
CI
Santiago
L
L
Abularrage
J
J
Jabbar
H
H
D000041:Absenteeism; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003191:Comprehensive Health Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D009519:New York City; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D012189:Retrospective Studies; D013256:Steroids; D017749:Total Quality Management / Q000458:organization & administration*
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids