Michelle M Cloutier1, Dorothy B Wakefield. 1. Asthma Center, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106, USA. mclouti@ccmckids.org
Abstract
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.
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.
Authors: Thomas G Rundall; Stephen M Shortell; Margaret C Wang; Lawrence Casalino; Thomas Bodenheimer; Robin R Gillies; Julie A Schmittdiel; Nancy Oswald; James C Robinson Journal: BMJ Date: 2002-10-26
Authors: Michelle M Cloutier; Scott D Grosse; Dorothy B Wakefield; Tursynbek A Nurmagambetov; Clive M Brown Journal: Am J Manag Care Date: 2009-06 Impact factor: 2.229
Authors: Michelle M Cloutier; Howard Tennen; Dorothy B Wakefield; Kevin Brazil; Charles B Hall Journal: Acad Pediatr Date: 2012-05-26 Impact factor: 3.107
Authors: Bruce D Levy; Patricia J Noel; Michelle M Freemer; Michelle M Cloutier; Steve N Georas; Nizar N Jarjour; Carole Ober; Prescott G Woodruff; Kathleen C Barnes; Bruce G Bender; Carlos A Camargo; Geoff L Chupp; Loren C Denlinger; John V Fahy; Anne M Fitzpatrick; Anne Fuhlbrigge; Ben M Gaston; Tina V Hartert; Jay K Kolls; Susan V Lynch; Wendy C Moore; Wayne J Morgan; Kari C Nadeau; Dennis R Ownby; Julian Solway; Stanley J Szefler; Sally E Wenzel; Rosalind J Wright; Robert A Smith; Serpil C Erzurum Journal: Am J Respir Crit Care Med Date: 2015-12-01 Impact factor: 21.405
Authors: Katharine E Zuckerman; Alison E Chavez; Laura Wilson; Katie Unger; Colleen Reuland; Katrina Ramsey; Margaret King; Julie Scholz; Eric Fombonne Journal: Autism Date: 2020-09-14