Consistency of care with national guidelines for children with asthma in managed care

• Published in: The Journal of pediatrics 2001-01, Vol.138 (1), p.59-64
• Main Authors: Diette, Gregory B., Skinner, Elizabeth A., Markson, Leona E., Algatt-Bergstrom, Pamela, Nguyen, Theresa T.H., Clark, Rebecca D., Wu, Albert W.
• Format: Article
• Language: English
• Subjects: Adolescent; Asthma - diagnosis; Asthma - etiology; Asthma - therapy; Attitude to Health; Biological and medical sciences; Child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Cross-Sectional Studies; Female; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Health Services Research; Humans; Male; Managed Care Programs - standards; Managed Care Programs - statistics & numerical data; Medical sciences; Midwestern United States; Needs Assessment - organization & administration; New England; Outcome Assessment (Health Care); Parents - education; Parents - psychology; Patient Education as Topic - standards; Pediatrics - methods; Pediatrics - standards; Pediatrics - statistics & numerical data; Pneumology; Practice Guidelines as Topic; Quality Indicators, Health Care; Quality of Health Care; Severity of Illness Index; Surveys and Questionnaires; Total Quality Management - organization & administration
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/mpd.2001.109600

Objective: To evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines. Design: Cross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity. Results: Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing. Conclusions: There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist. (J Pediatr 2001;138:59-64)