Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. S145-S151 (doi:10.1542/peds.2005-2000L)
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SUPPLEMENT ARTICLE

Change in Approach and Delivery of Medical Care in Children With Asthma: Results From a Multicenter Emergency Department Educational Asthma Management Program

Rodney B. Boychuk, MDa,b, Charles J. DeMesa, MPHa, Kristi M. Kiyabu, MEda, Franklin Yamamoto, MDb, Loren G. Yamamoto, MD, MPH, MBAa,b, Ron Sanderson, RRT, MEd, DrPHc, Brenda Gartner, RNd, Rebecca Donovan, RNd, Sheila Beckham, MPHe, Corilyn Pang, BAa, Rebecca Fanucchi, RRTa and Valerie Chong, RRTa

a Emergency Department and Robert Wood Johnson Asthma Grant Program, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii
b Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
c Castle Medical Center, Kailua, Hawaii
d Kaiser Permanente Medical Center, Honolulu, Hawaii
e Waianae Coast Comprehensive Health Center, Waianae, Hawaii

OBJECTIVES. The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers.

METHODS. The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003) and phase II (October 1, 2003, to July 8, 2004). Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II.

RESULTS. Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention.

CONCLUSION. An ED-based childhood asthma tracking system can serve as a basis for designing and implementing an ED-based educational intervention. ED staff, primary care providers, and others can work together to promote asthma care.

Key Words: pediatric asthma • patient self-management education • emergency department

Abbreviations: QoL—quality of life • NAEPP—National Asthma Education and Prevention Program • CARES—Child Asthma Research to Elevate Standards • ED—emergency department • KMCWC—Kapiolani Medical Center for Women and Children • PCP—primary care provider • CME—continuing medical education

Accepted Dec 6, 2005.