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Consistency of care with national guidelines for children with asthma in managed care
G B Diette1, E A Skinner, L E Markson
1Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
Insights
Pediatric asthma care often falls short of national guidelines. Many children with persistent asthma symptoms lack daily control medication, written asthma action plans, and essential diagnostic testing, indicating a need for improved care quality.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Asthma Management
Background:
- Adherence to national guidelines is crucial for effective pediatric asthma management.
- Managed care organizations play a significant role in delivering healthcare to children with asthma.
- Assessing care consistency with established guidelines identifies areas for quality improvement.
Purpose of the Study:
- To evaluate the adherence of pediatric asthma care to the National Asthma Education and Prevention Program Guidelines.
- To identify specific deficiencies in the care provided to children with asthma within managed care settings.
Main Methods:
- A cross-sectional survey was conducted with parents of children (n=318) aged 5-17 years with asthma.
- Data were collected on four key domains: physiologic assessment, medication use, patient education, and environmental control.
- No interventions were performed; the study focused on existing care practices.
Main Results:
- Significant gaps in care were observed across all domains evaluated.
- For children with moderate to severe persistent asthma, only 55% used daily long-term control medication.
- Less than half of the children received written asthma action plans (49%) or underwent allergy testing (56%) and pulmonary function testing (54%).
Conclusions:
- There are substantial opportunities to enhance the quality of asthma care for children within managed care systems.
- A multifaceted approach is required to address the identified deficiencies and improve overall asthma management.
- Improving pediatric asthma care quality necessitates addressing medication adherence, patient education, and diagnostic assessments.
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.
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