PEDIATRICS Vol. 98 No. 1 July 1996, pp. 18-23
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Does Quality of Care Affect Rates of Hospitalization for Childhood Asthma?

Charles J. Homer MD, MPH1, Peter Szilagyi MD, MPH2, Lance Rodewald MD, MPH2, Sheila R. Bloom MS3, Peter Greenspan MD4, Susan Yazdgerdi MS3, John M. Leventhal MD5, Dianne Finkelstein PhD6, and James M. Perrin MD4

1 Children's Hospital, Boston; Department of Pediatrics, Harvard Medical School, Boston
2 Department of Pediatrics, Strong Memorial Hospital and University of Rochester School of Medicine, Rochester
3 Massachusetts General Hospital, Boston
4 Department of Pediatrics, Harvard Medical School, Boston; Massachusetts General Hospital, Boston
5 Department of Pediatrics, Yale University School of Medicine, New Haven
6 Department of Biostatistics, Harvard School of Public Health, Boston

Background. Hospitalization rates for childhood asthma are three times as high in Boston, Massachusetts, as in Rochester, New York; New Haven, Connecticut, rates are intermediate. We undertook this study to determine how care for children admitted for asthma varies across these communities.

Methods. We performed a community-wide retrospective chart review. We reviewed a random sample of all asthma hospitalizations, from 1988 to 1990, of children 2 to 12 years old living in these communities (n = 614). Abstracted data included demographics, illness severity, and treatment before admission.

Results. Compared with Rochester children, Boston children were less likely to have received maintenance preventive therapy (inhaled corticosteroids or cromolyn [odds ratio (OR), 0.4 (0.2, 0.9)]), acute "rescue" therapy (oral corticosteroids [OR, 0.2 (0.1, 0.4)]), or inhaled betaagonist therapy [OR, 0.5 (0.3, 1.0)]. A larger proportion of admitted asthmatic patients in Boston (34%) were in the least severely ill group—oxygen saturation 95% or above—compared with patients in Rochester (20%).

Conclusions. The quality of ambulatory care, including choice of preventive therapies and thresholds for admission, likely plays a key role in determining community hospitalization rates for chronic conditions such as childhood asthma.

Submitted on April 27, 1995
Accepted on August 24, 1995




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