title: The impact of allergy and pulmonary specialist care on emergency asthma utilization in a large managed care organization.
abstract: OBJECTIVE
  To evaluate the longitudinal impact of asthma specialist care on the risk of emergency department (ED) visits and hospitalization for asthma.
  
  
  METHODS
  A prospective cohort study using both telephone survey and computerized utilization data.
  
  
  METHODS
  We recruited a prospective cohort of 4,742 adult members of a closed panel managed care organization who were hospitalized for asthma (the "baseline hospitalization").
  
  
  METHODS
  Visits to asthma specialists were ascertained from computerized utilization databases. Specialist visits after baseline hospitalization were defined as time-dependent covariates. An alternative analysis defined specialist visits during the year preceding baseline hospitalization. A subcohort of 596 subjects completed telephone interviews.
  
  
  RESULTS
  Compared with subjects who received no specialist visits after baseline hospitalization, treatment by allergists (hazard ratio (HR) 1.04; 95 percent confidence interval (CI) 0.87-1.26) or pulmonologists (HR 0.92; 95 percent CI 0.71-1.19) was not associated with a reduction in the risk of future ED visits for asthma in the entire cohort, controlling for age, sex, race, recent asthma medication dispensing, and pharmacy benefits status. There was also no association between allergist visits and the risk of subsequent hospitalizations for asthma (HR 0.93; 95 percent CI 0.75-1.14). In contrast, visits to pulmonologists (HR 0.74; 95 percent CI 0.55-0.99) were related to a reduced risk of rehospitalization.
  
  
  CONCLUSIONS
  Pulmonary specialist visits appeared to reduce the risk of hospitalization for asthma, whereas asthma specialist visits did not reduce the risk of ED visits. In the context of comprehensive prepaid health care, the benefit of specialist care was modest.
authors.affiliation: Department of Medicine, University of California, San Fransisco, 350 Parnassus Avenue, Ste 609, San Francisco, CA 94117, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Erickson
authors.forename: Irina
authors.initials: I
authors.lastname: Tolstykh
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: Guillermo
authors.initials: G
authors.lastname: Mendoza
authors.forename: Carlos
authors.initials: C
authors.lastname: Iribarren
authors.forename: Mark D
authors.initials: MD
authors.lastname: Eisner
mesh_terms: D000328:Adult; D000486:Allergy and Immunology / Q000458:organization & administration / Q000706:statistics & numerical data*; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002140:California; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000458:organization & administration / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014600:Utilization Review