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Translation of a pediatric asthma-management program into a community in Connecticut
Michelle M Cloutier1, Dorothy B Wakefield
1Asthma Center, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106, USA. mclouti@ccmckids.org
Insights
General pediatricians can effectively implement an asthma management program, improving care and reducing hospitalizations and emergency visits for children with persistent asthma.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Public Health
Background:
- Asthma management programs have shown success in specialized settings.
- Translating these programs into general pediatric practice is crucial for broader impact.
- Improving pediatric asthma care requires accessible and scalable interventions.
Purpose of the Study:
- To assess the feasibility and effectiveness of implementing a successful asthma management program in general pediatrician's offices.
- To evaluate the program's impact on healthcare quality and utilization of medical services for children with asthma.
- To determine if general pediatricians can improve asthma care for a large pediatric population.
Main Methods:
- A multi-site implementation study involving 51 pediatric practices across 6 Connecticut communities.
- Training of pediatric clinicians on a standardized asthma management program.
- Enrollment of 32,680 children, with a focus on 10,467 diagnosed with asthma, including 4,354 insured by Medicaid.
- Quality metrics included enrollment, anti-inflammatory therapy use, and treatment plan distribution.
- Analysis of medical services utilization (hospitalizations, emergency department visits, outpatient visits) using relative rates (RRs) and generalized estimating equations.
Main Results:
- Significant reductions in hospitalizations (RR: 0.51) and emergency department visits (RR: 0.70) for children with persistent asthma.
- No significant change observed in outpatient visit frequency (RR: 0.99).
- Doubled use of inhaled corticosteroids, with appropriate anti-inflammatory therapy reaching 96% and 94% of children receiving a written treatment plan.
Conclusions:
- General pediatricians can successfully implement a structured asthma management program.
- The program effectively improves asthma care quality and reduces acute healthcare utilization in a large pediatric population.
- This model demonstrates a scalable approach to enhancing pediatric asthma management within primary care settings.
Objectives:
We assessed whether a successful asthma-management program could be translated into pediatrician's offices, improve care, and reduce medical services use.
Methods:
Pediatrician's offices from 6 communities in Connecticut were trained, and all children aged 6 months or older were eligible for enrollment. Quality measures included enrollment numbers, appropriate use of anti-inflammatory therapy, and distribution of a written treatment plan. Medical services utilization data for Medicaid-insured children were expressed as relative rates (RRs) (95% confidence intervals [CIs]) before and after enrollment, and we used historical and contemporaneous comparisons and generalized estimating equations.
Results:
A total of 51 practices and 297 clinicians enrolled 32 680 children from 2002 to 2007; 10 467 had asthma, of whom 4354 were insured with Medicaid. Children with persistent asthma experienced decreases in the number of hospitalizations (RR: 0.51 [95% CI: 0.39-0.65]) and emergency-department visits (RR: 0.70 [95% CI: 0.68-0.84]), and there was no change in number of outpatient visits (RR: 0.99 [95% CI: 0.9-1.10]). Inhaled corticosteroid use doubled, appropriate use of anti-inflammatory therapy increased to 96%, and 94% of the children were given a written treatment plan.
Conclusions:
General pediatricians can successfully implement an asthma-management program that is effective in improving care for large numbers of children.
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