Specialty care improves outcome in childhood asthma

By means of a retrospective cohort analysis, we studied the impact of speci alty care on health care costs and clinical outcomes in children with moder ate to severe asthma, Fifteen patients with a median age of 9 +/- 7 years w ith at least three emergency department (ED) visits and one hospital admiss ion (HA) for asthma were identified, Patients need to be followed for at le ast 1 year at the Childhood Asthma Care and Education Center (CACEC) to be eligible for this study. A stepwise approach to treatment was applied accor ding to clinical severity, Follow-up was done quarterly by the asthma manag ement team in coordination with the primary care physician. Pulmonary funct ion parameters, clinical outcomes, and hospital charges were compared befor e and after referral to the CACEC, A 67% reduction in HA rate per year (p < 0.005) and a 75% reduction in ED utilization per year (p = 0.02) were obse rved, Pulmonary function tests (PFTs) showed significant improvement. The f orced expiratory volume in 1 second (FEV1) increased from 63 to 80% of that predicted (p = 0.0006), In addition, the forced expiratory flow between 25 and 75% of the vital capacity (FEF25-75%), a marker of small airway functi on, increased from 37 to 47% of the predicted values for age (p = 0.03). Th e estimated mean hospital charges decreased by $3800 per patient per year a fter study enrollment. Appropriate referral to asthma specialists leads to an improved clinical outcome, decreased health care expenditures, and impro ved pulmonary function in children with moderate to severe asthma.