OUTPATIENT MANAGEMENT-PRACTICES ASSOCIATED WITH REDUCED RISK OF PEDIATRIC ASTHMA HOSPITALIZATION AND EMERGENCY DEPARTMENT VISITS

Objectives. Effective outpatient care is believed to prevent hospitali zation and emergency department (ED) visits resulting from childhood a sthma. The aim of this study was to suggest priority areas for interve ntion by identifying outpatient management practices associated with t he risk of these adverse outcomes in a large population. Methods. This case-control study included children aged 0 to 14 years with asthma w ho were members of a regional health maintenance organization. Cases w ere children undergoing either a hospitalization or an ED visit for as thma during the study period. Control subjects were children with asth ma without a hospitalization or an ED visit during the study period wh o were matched to patients on age, gender, and number of asthma-relate d hospitalizations in the past 24 months. Data on provider and parent asthma management practices were collected using chart review, closed- ended telephone interviews with parents, and computerized use database s. Multivariate analyses were conducted using conditional logistic reg ression models. Results. Data were collected on 508 cases and 990 cont rol subjects. A total of 43% of cases were reported by their parents t o have moderately severe or severe asthma, compared with 20% of contro l subjects. Parents of cases with hospitalization were less likely tha n control subjects to have a written asthma management plan (44% vs 51 %) and to report washing bedsheets in hot water at least twice a month (77% vs 86%). Cases with hospitalization were more likely to have a n ebulizer (74% vs 56%). In the final multivariate model, race/ethnicity was not associated with having had either a hospitalization or an ED visit, as was lower socioeconomic status. Having a written asthma mana gement plan [odds ratio (OR): 0.54; 95% confidence interval (CI): 0.30 , 0.99] and washing bedsheets in hot water at least twice a month (OR: 0.45; 95% CI: 0.21, 0.94) were associated with reduced odds of hospit alization. Having a written asthma management plan (OR: 0.45; 95% CI: 0.27, 0.76) and starting or increasing medications at the onset of a c old or flu were associated with reduced odds of making an ED visit. Co nclusions. Practices that support early intervention for asthma flare- ups by parents at home, particularly written management plans, are str ongly associated with reduced risk of adverse outcomes among children with asthma.