Consistency of care with national guidelines for children with asthma in managed care

Objective: To evaluate the consistency of pediatric asthma care with the Na tional Asthma Education and Prevention Program Guidelines. Design: Cross-sectional survey at 2 managed care organizations in the Unite d States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outco me measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) c ontrol of factors contributing to asthma severity. Results: Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years . Deficiencies in care were identified in all care domains including, for p atients with moderate and severe persistent symptoms, only 55% used long-te rm control medication daily, 49% had written instructions for handling asth ma attacks, 44% had instructions for adjustment of medication before exposu res, 56% had undergone allergy testing, and 54% had undergone pulmonary fun ction testing. Conclusions: There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive app roach to improving care may be necessary to address multiple aspects of car e where opportunities exist.