Documenting asthma severity: do we get it right?
BACKGROUND
The 1997 National Asthma Education and Prevention Program (NAEPP) recommends a severity classification scheme to optimize the use of anti-inflammatory therapy for persistent asthma. Physician documentation of asthma severity is often used as a quality assurance measure.


OBJECTIVE
To test the hypothesis that physician documentation of asthma severity is associated with appropriate use of anti-inflammatory therapy.


METHODS



METHODS
inner-city academic health center. First, we reviewed a consecutive sample of charts of scheduled pediatric patients. Then, we administered a structured parent survey regarding the child's asthma symptoms and current asthma therapy. We used NAEPP guidelines to classify patients' severity of asthma. The main outcome measure was appropriate use of anti-inflammatory therapy. Appropriate therapy was defined as: (1) mild persistent asthmatics using anti-inflammatory therapy, and (2) moderate-severe persistent asthmatics using inhaled steroids. Chart classification of asthma severity was compared with the NAEPP-applied classification.


RESULTS
Of 784 charts, 214 (27%) were asthmatic. Of these, 176 (82%) were surveyed. The mean age was 7.4 years; 61% were males. Severity classification was documented in 77% of charts. Chart documentation differed significantly from survey classification for the same patients: (mild intermittent 54% vs. 40%, mild persistent 21% vs. 14%, moderate persistent 24% vs. 36%, severe persistent 1% vs. 10%; all p < .001). Correctly classified patients were more likely to be on appropriate therapy.


CONCLUSIONS
Physicians underestimated the severity classification of asthmatic patients. Incorrect classification was associated with inappropriate asthma therapy. These findings have implications for the institution of asthma quality improvement programs.
Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York 10467, USA. sandrafb@juno.com
Sandra
S
Braganza
Iman
I
Sharif
Philip O
PO
Ozuah
D000280:Administration, Inhalation; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011204:Poverty Areas; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents