title: Use of asthma guidelines by primary care providers to reduce hospitalizations and emergency department visits in poor, minority, urban children.
abstract: OBJECTIVE
  To determine whether an organized, citywide asthma management program delivered by primary care providers (PCPs) increases adherence to the National Asthma Education and Prevention Program (NAEPP) Asthma Guidelines and whether adherence to the guidelines by PCPs decreases medical services utilization in low-income, minority children.
  
  
  METHODS
  Analysis of the utilization of medical services for a cohort of 3748 children with asthma who presented for care at one of six primary care urban clinics in Hartford, Connecticut, and who were enrolled in a disease management program (Easy Breathing) between June 1, 1998 and August 31, 2002.
  
  
  RESULTS
  Of the 3748 children with physician-confirmed asthma, 48% had persistent disease. Paid claims for inhaled corticosteroids increased 25% ( P <.0001) after enrollment in Easy Breathing. Provider adherence to the NAEPP guidelines for anti-inflammatory therapy increased from 38% to 96%. Easy Breathing children with asthma experienced a 35% decrease in overall hospitalization rates ( P <.006), a 27% decrease in asthma emergency department (ED) visits ( P <.01), and a 19% decrease in outpatient visits ( P <.0001).
  
  
  CONCLUSIONS
  An organized, disease management program increased adherence to the NAEPP guidelines for anti-inflammatory use by PCPs in urban clinics. Adherence to this element of the guidelines by PCPs reduced hospitalizations, ED visits, and outpatient visits for children with asthma.
authors.affiliation: Department of Pediatrics, University of Connecticut Health Center and Asthma Center, and Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA. mcclouti@ccmckids.org
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cloutier
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Dorothy B
authors.initials: DB
authors.lastname: Wakefield
authors.forename: Howard
authors.initials: H
authors.lastname: Bailit
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008913:Minority Groups; D011203:Poverty; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014505:Urban Population
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents