The CGHA Asthma Management Program and Its Effect Upon Pediatric Asthma Admission Rates

Abstract

Asthma is the most common reason for admission to the hospital for children nationally. This hospitalization rate is stable despite availability of appropriate outpatient treatments. Our Cincinnati Group Health Associates (CGHA) asthma management program has evolved since 1989. We have measured our pediatric population along with asthma admissions since 1993. Our admission pattern is compared to the community in general and to our managed care population in particular. Our urban center's admission pattern is also studied. Our CGHA pediatric asthma admissions have been declining steadily over the 1993-2000 period by 60%. This decrease is in contrast to national trends in this time period. Comparison to total admissions from 1993 through 2000 still shows a 50% decline whether 0-18 years or 0-5 years is studied. Our urban pediatric center also had a fall in pediatric asthma admission rates of 80% in this time frame; all of these results are statistically significant. Our major managed care network also showed a decline of 55% in pediatric asthma admissions from 1996 to 1999. Our CGHA asthma management program has had a positive influence on our pediatric asthma admission rates. This effect is favorable in comparison to national trends in pediatric asthma admissions. This trend is independent of disease acuity, region of the city where patients live, insurance selection, or age.

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References

1. Centers for Disease Control and Prevention . Forecasted State-Specific Estimates of Self-Reported Asthma Prevalence-United States. MMWR. 1998;47:1022-1025.

2. Weinberger M. Asthma-a Problem of health care delivery. Allergy Asthma Proc. 1999;20:57-65.

3. Asthma prevention program of the National Center for Environmental Health, Centers for Disease Control and Prevention At a Glance. 1999 Centers for Disease Control and Prevention Web site. Available at http://www.cdc.gov/nceh/programs/asthma/ataglnce/asthmaag2.htm. Accessed June, 2000.

4. Myers TR . Pediatric asthma epidemiology. Respir Care Clin North Am. 2000;6:1-14.

5. Centers for Disease Control and Prevention . Asthma Mortality and Hospitalization Among Children and Young Adults-United States, 1980-1993. Immun Weekly. 1996;45:350-353.

6. Goodman DC , Stukel TA , Chang C. Trends in pediatric asthma hospitalization rates: regional and socioeconomic differences. Pediatrics. 1998;101:208-213.

7. Lin S , Fitzgerald E , Hwang S , et al. Asthma hospitalization rates and socioeconomic status in New York State. JAsthma. 1999;36:239-251.

8. Claudio L , Tulton L , Doucette J , Landeran PJ . Socioeconomic factors and asthma hospitalization rates in New York City. JAsthma. 1999;36:343-350.

9. Gilthopre MS , Lay-Yee R , Wilson RC , et al. Variations in hospitalization rates for asthma among black and minority ethnic communities. Respir Med. 1998;92:642-648.

10.

10. Diaz T , Starm T , Matte T , et al. Medication use among children with asthma in East Harlem. Pediatrics. 2000;105:1188-1193.

11.

11. Newacheck PN , Hov Son N. Prevalence, impact, and trends in childhood disability due to asthma. Arch Pediatr Adolesc Med. 2000;154:287-293.

12.

12. Smith DH , Malone DC , Lawson KA . A national estimate of the economic costs of asthma. Am J Resp Crit Care Med. 1997;156:787-793.

13.

13. National Asthma Education Program . Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD. National Heart, Lung, and Blood Institute. LISDHHS Publication. 1991; No. 91-3042.

14.

14. National Asthma Education and Prevention Program . Expert Panel Report II. Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD. National Heart, Lung and Blood Institute. 1997; No. 97-4051.

15.

15. Cabana MD , Ebel BE , Cooper-Patrick L , et al. Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med. 2000;154:685-693.

16.

16. Legorreta AP , Christian-Herman J , O'Conner RD. Compliance with national asthma management guidelines and speciality care: a health maintenance organization experience. Arch Intern Med. 1997;157:1201-1208.

17.

17. Stoloff SW . The 1997 asthma guidelines and an asthma clinical update. Am J Managed Care. 2000;6 (suppl): 5327-5335.

18.

18. Flores G , Lee M , Bauchner H , Kastner B. Pediatricians attitudes, beliefs, and practices regarding clinical practice guidelines: a national survey. Pediatrics. 2000;105:496-501.

19.

19. National Center for Health Statistics . 1998-1999. Healthy People 2000 Review. Hyattsville, MD, Public Health Service.

20.

20. Lawrence L , Hall MJ . 1997 Summary: National Hospital Discharge Survey. Vital and Health Statistics of the CDC/NCHS. 1999. No. 308:1-16.

21.

21. Hall MJ , Popovic JR . 1998 Summary: National Hospital Discharge Survey. Vital and Health Statistics of the CDC/NCHS. 2000. No. 316:1-17.

22.

22. Personal communication. Cincinnati Children's Hospital Medical Center Information Systems Office. May 2000.

23.

23. Personal communication. Pam Mallory, Paragon Health System, Cincinnati, Ohio. April 2000.

24.

24. Dawson KP , Van Asperen P , Higgins C , et al. An evaluation of the action plans of children with asthma. J Pediatr Child Health. 1995;31:21-23.

25.

25. Lieu TA , Quesenberry CP Jr , Capra AM , et al. Outpatient management practices associated with reduced risk of pediatric asthma hospitalizations and emergency department visits. Pediatrics. 1997;100:334-341.

26.

26. Mehr TA , Evans R III . Allergist influence on asthma care. Ann Allergy. 1993;71:115-120.

27.

27. Moore CM , Ahmed I , Mouallen R , et al. Care of asthma: allergy clinic versus emergency room. Ann Allergy Immunol. 1997;78:373-380.

28.

28. Vilar ME , Reddy BM , Silverman BA , et al. Superior clinical outcomes of inner city asthma patients treated in an allergy clinic. Ann Allergy Asthma Immunol. 2000;84:299-303.

29.

29. Kelly CS , Morrow AL , Shultz J , et al. Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in Medicaid. Pediatrics. 2000;105:1029-1035.

30.

30. Jowers JR , Schwartz AL , Tinkelman DG , et al. Disease management program improves asthma outcomes. Am J Managed Care. 2000;6:585-592.

31.

31. Unpublished guidelines. O'Brien K. Inpatient pediatric asthma care guidelines for group Health Associates. 1997.

32.

32. Unpublished guidelines. Children's Hospital Medical Center. Health policy and clinical effectiveness program. Evidence-based clinical practice guideline for managing an acute exacerbation of asthma. 1999.

33.

33. Unpublished guidelines for acute pediatric care. Raub J. Cincinnati Group Health Associates, 1999.