Improving pediatric asthma care through surveillance: the Illinois Emergency Department Asthma Collaborative.
OBJECTIVE
To better understand and improve the care of asthma patients who require emergency department (ED) care, the Illinois Emergency Department Asthma Collaborative (IEDAC) was created to develop, test, and disseminate an ED-based surveillance system. This report describes the development and testing of the pediatric IEDAC surveillance instruments and demonstrates how these instruments can be used to describe the health status, healthcare delivery, and outcome of children using ED services.


METHODS
A convenience sample of 128 children presenting to 5 EDs in Illinois for asthma care was the study base. Data were collected on monthly samples of children aged 2 through 17 years who presented to these EDs from May to November 2003. Three instruments were used to collect data regarding the children's pre-ED, ED, and post-ED experience.


RESULTS
At the ED visit, 73.4% of children met national guideline criteria for persistent-level asthma symptoms. Among this group, 53.2% were using inhaled corticosteroid (ICS) medications. At 1 month follow-up, 66.6% of the children met the criteria for persistent-level asthma symptoms, which was statistically unchanged from the ED visit. Among the latter group, 64.2% were using ICS medications, again statistically unchanged compared with the ED visit. At follow-up, 24.5% of children were reported to have returned to an ED or were subsequently hospitalized. The majority of children were noted at follow-up to have limitation of at least some activity.


CONCLUSIONS
Children who presented to IEDAC EDs were found to have a high level of asthma burden that continued at follow-up despite treatment. Moreover, a substantial proportion of children had returned to an ED or were subsequently hospitalized. Encouraging trends in medication use were observed, although suboptimal medication use was also observed.
Lenhardt
Richard O
RO
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 297, Chicago, Illinois 60612, USA. richard_lenhardt@rush.edu
Catrambone
Catherine D
CD
McDermott
Michael F
MF
Walter
James
J
Williams
Seymour G
SG
Weiss
Kevin B
KB
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D002641:Chicago / Q000453:epidemiology; D002648:Child; D002662:Child Health Services / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011159:Population Surveillance; D018570:Risk Assessment
D018927:Anti-Asthmatic Agents