title: Heterogeneity in asthma care in a statewide collaborative: the Ohio Pediatric Asthma Repository.
abstract: OBJECTIVE
  Asthma heterogeneity causes difficulty in studying and treating the disease. We built a comprehensive statewide repository linking questionnaire and medical record data with health outcomes to characterize the variability of clinical practices at Ohio children's hospitals for the treatment of hospitalized asthma.
  
  
  METHODS
  Children hospitalized at 6 participating Ohio children's hospitals for asthma exacerbation or reactive airway disease aged 2 to 17 were eligible. Medical, social, and environmental histories and past asthma admissions were collected from questionnaires and the medical record.
  
  
  RESULTS
  From December 2012 to September 2013, 1012 children were enrolled. There were significant differences in the population served, emergency department and inpatient practices, intensive care unit usage, discharge criteria, and length of stay across the sites (all P < .0001, total n = 1012). Public insurance was highest in Cleveland and Cincinnati (72 and 65%). In the emergency department, Cincinnati and Akron had the highest intravenous magnesium sulfate use (37% and 33%); Columbus administered the most intramuscular epinephrine (15%). Cleveland and Columbus had the highest intensive care unit admittance (44% and 41%) and proportion of long-stay patients (95% and 85%). Moderate/severe asthma severity classification was associated with discharge prescription for inhaled corticosteroids (odds ratio = 2.7; 95% confidence interval: 1.6-4.5; P = .004) but not stay length.
  
  
  CONCLUSIONS
  These data highlight the need for standardization of treatment practices for inpatient asthma care. There is considerable opportunity for personalized care plans that incorporate a patient's asthma impairment, risk, and treatment response history into hospital practices for asthma exacerbation treatment. The Ohio Pediatric Asthma Repository is a unique statewide resource in which to conduct observational, comparative effectiveness, and ultimately intervention studies for pediatric asthma.
authors.affiliation: Divisions of Asthma Research.
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Biagini Myers
authors.affiliation: Hospital Medicine.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Simmons
authors.affiliation: Pulmonary Medicine, and.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Kercsmar
authors.affiliation: Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Martin
authors.affiliation: Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Valentina V
authors.initials: VV
authors.lastname: Pilipenko
authors.affiliation: Divisions of Asthma Research.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Austin
authors.affiliation: Divisions of Asthma Research.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lindsey
authors.affiliation: Divisions of Asthma Research.
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Amalfitano
authors.affiliation: Pulmonary Medicine, and.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.affiliation: Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, Ohio;
authors.forename: Karen S
authors.initials: KS
authors.lastname: McCoy
authors.affiliation: Department of Pediatrics, Dayton Children's Hospital, Dayton, Ohio;
authors.forename: Shalini G
authors.initials: SG
authors.lastname: Forbis
authors.affiliation: Department of Pulmonary Medicine, Akron Children's Hospital, Akron, Ohio;
authors.forename: John T
authors.initials: JT
authors.lastname: McBride
authors.affiliation: Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, Ohio; and.
authors.forename: Kristie R
authors.initials: KR
authors.lastname: Ross
authors.affiliation: Department of Pediatric Pulmonary Medicine, ProMedica Toledo Children's Hospital, Toledo, Ohio.
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Vauthy
authors.affiliation: Divisions of Asthma Research, gurjit.hershey@cchmc.org.
authors.forename: Gurjit K
authors.initials: GK
authors.lastname: Khurana Hershey
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000145:classification / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009820:Ohio; D010343:Patient Admission / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: children; clinical practices; inpatient asthma; repository