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Dedicated asthma center improves the quality of care and resource utilization for pediatric asthma: a multicenter
D S Battleman1, M A Callahan, S Silber
1Office of Outcomes Research, Department of Public Health, New York Presbyterian Healthcare System, Weill Medical College of Cornell University, New York, NY 10021, USA. dsbattle@med.cornelle.edu
Insights
Pediatric asthma care at a dedicated asthma center (AC) significantly improves quality and access compared to emergency department (ED) use. AC patients experience fewer hospitalizations and less school absenteeism, highlighting the benefits of specialized care.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Public Health
Background:
- Asthma is a common chronic respiratory disease in children.
- Current pediatric asthma management often involves fragmented care, particularly for children relying on emergency departments (EDs).
- Dedicated asthma centers (ACs) offer specialized, multidisciplinary care for pediatric asthma patients.
Purpose of the Study:
- To compare the effectiveness of pediatric asthma care provided by a dedicated asthma center (AC) versus care managed through the emergency department (ED).
- To evaluate differences in quality of care, access to services, hospital utilization, and functional impact of asthma between AC and ED patient groups.
Main Methods:
- Retrospective case-control study design.
- Matched cohorts (1:2 ratio) of pediatric asthma patients from a dedicated AC and from ED visits across five urban hospitals.
- Data collected via telephone surveys of caregivers, focusing on medication use, physician access, and impact on school and work.
Main Results:
- AC patients demonstrated superior quality of care, with higher rates of anti-inflammatory medication use (60.2% vs 22.5%) and medication adherence at school (71.4% vs 48.1%).
- AC families reported significantly better access to a physician for outpatient management (98.2% vs 65.0%).
- AC patients experienced less frequent ED utilization (9.2% vs 22.0% for ≥1 visit/month), reduced school absenteeism (9.5 vs 16.6 days), and fewer workdays missed by caregivers (4.7 vs 7.4 days).
Conclusions:
- Significant disparities exist in the quality, access, resource utilization, and functional impact of asthma care between dedicated ACs and ED-based care.
- Emergency physicians play a crucial role in improving pediatric asthma outcomes by referring patients to specialized ACs.
- Directing children with asthma to dedicated centers can optimize care and reduce the burden of the disease on patients and families.
Objectives:
To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care.
Methods:
A retrospective case-control design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12-month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample.
Results:
Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (> or = 1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 +/- 6.7 days vs 16.6 +/- 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 +/- 2.8 vs 7.4 +/- 4.1; p = 0.03).
Conclusions:
Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment.
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