Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1880-1887 (doi:10.1542/peds.2006-1019)
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ARTICLE

Asthma Guideline Use by Pediatricians in Private Practices and Asthma Morbidity

Michelle M. Cloutier, MDa,b, Dorothy B. Wakefield, MSb, Pamela Sangeloty-Higgins, MS, MPHb, Steven Delaronde, MPH, MSWc and Charles B. Hall, PhDd

a Asthma Center, Connecticut Children's Medical Center, Hartford, Connecticut
b Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
c ConnectiCare, Farmington, Connecticut
d Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York

OBJECTIVE. We sought to examine whether pediatric clinicians in private, non–health maintenance organization practices could implement the national asthma guidelines and whether, when implemented, these guidelines would decrease medical services utilization and improve asthma care for children.

METHODS. A trial of a disease management program (Easy Breathing II) involving 20 private pediatric practices in the greater Hartford, Connecticut area was conducted between January 1, 2001, and December 31, 2003. Demographic data on participating practitioners and patients were obtained from questionnaires. Medical services utilization data from claims were obtained from ConnectiCare, a regional managed care organization.

RESULTS. Of the 16750 children enrolled in Easy Breathing II, 2458 were enrolled in ConnectiCare and 490 had asthma. Inhaled corticosteroid use increased in the community overall during the study period. After enrollment in Easy Breathing II, with adjustment for age, gender, ethnicity, asthma severity, season, and calendar year, children with persistent asthma experienced an additional 47% increase in inhaled corticosteroid use, a 56% reduction in outpatient visits, and a 91% decrease in emergency department visits for treatment of asthma. Adherence to national asthma guidelines for prescribing inhaled corticosteroids was 95%. Seventeen of the 20 practices are still using Easy Breathing, 5 years after program implementation.

CONCLUSIONS. Pediatric primary care clinicians in private practice settings can implement an asthma management program patterned after the national asthma guidelines. When implemented, this program is successful in reducing medical services utilization for children with asthma. Just as differences in patterns of medical services utilization exist in private practices, compared with urban clinics, the impact of disease management on medical services utilization differs in private practices, compared with urban clinics.

Key Words: Easy Breathing • disease management • children • National Asthma Education and Prevention Program • medical services utilization • claims data

Abbreviations: NAEPP—National Asthma Education and Prevention Program • EPR—Expert Panel Report • ED—emergency department • ICS—inhaled corticosteroid • MCO—managed care organization • CI—confidence interval

Accepted Jun 13, 2006.