title: Change in approach and delivery of medical care in children with asthma: results from a multicenter emergency department educational asthma management program.
abstract: OBJECTIVE
  The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers.
  
  
  METHODS
  The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003) and phase II (October 1, 2003, to July 8, 2004). Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II.
  
  
  RESULTS
  Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention.
  
  
  CONCLUSIONS
  An ED-based childhood asthma tracking system can serve as a basis for designing and implementing an ED-based educational intervention. ED staff, primary care providers, and others can work together to promote asthma care.
authors.affiliation: Emergency Department and Robert Wood Johnson Asthma Grant Program, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, USA. rodb@kapiolani.org
authors.forename: Rodney B
authors.initials: RB
authors.lastname: Boychuk
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Demesa
authors.forename: Kristi M
authors.initials: KM
authors.lastname: Kiyabu
authors.forename: Franklin
authors.initials: F
authors.lastname: Yamamoto
authors.forename: Loren G
authors.initials: LG
authors.lastname: Yamamoto
authors.forename: Ron
authors.initials: R
authors.lastname: Sanderson
authors.forename: Brenda
authors.initials: B
authors.lastname: Gartner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Donovan
authors.forename: Sheila
authors.initials: S
authors.lastname: Beckham
authors.forename: Corilyn
authors.initials: C
authors.lastname: Pang
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fanucchi
authors.forename: Valerie
authors.initials: V
authors.lastname: Chong
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000517:prevention & control / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003695:Delivery of Health Care; D004502:Education, Medical, Continuing; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006254:Hawaii; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008297:Male; D010347:Patient Care Planning; D010353:Patient Education as Topic; D012648:Self Care