Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Asthma-Specific Quality Improvement Activities and Community Outreach
Asthma-Specific Quality Improvement Activities and Community Outreach
Approximately 58% of the hospitals indicated that they conducted utilization review for diagnoses of asthma in both the inpatient and outpatient settings. However, as seen in Table 2, the hospitals with practice guidelines for inpatient asthma management were much more likely to conduct utilization review (p < 0.01).
Just over one fifth of the responding hospitals had clinical case management programs for asthma, and few hospitals included home visits as part of their asthma management strategy. The frequencies of these activities did not vary by hospital location (urban/suburban) or academic status (see Table 2).
Forty-one percent of the hospitals reported conducting one or more of community-based asthma programs within the past 2 years. Figure 1 presents the frequency of each of four types of community-based programs (asthma screening, adult asthma education, pediatric asthma education, and school-based asthma education). The frequency of these community-based activities did not vary by hospital location or by academic status. canadian-familypharmacy.com
In 1996, there were an estimated 11,900 hospital discharges for persons with asthma in the Chicago area, or 42.8 discharges per 10,000 population. However, prior to this survey, little was known about the general characteristics of the asthma care delivered by the hospitals in this area. In 1991, the National Asthma Education and Prevention Program released an Expert Panel Report of guidelines for the diagnosis and management of asthma; in 1997, they released a revision of those guidelines. These reports provide a national standard for evaluating health-care performance and provide some guidance as to the minimal expectations for asthma care.
Table 2—Characteristics of Asthma-Related Quality Improvement and Community-Based Care in Chicago-Area Hospitals
|Characteristics||All Hospitals (n = 59)||Asthma Guidelines||p Value|
|Yes (n = 25)||No (n = 34)|
|Formal asthma education in outpatient setting, %||35.7||39.1||35.3||0.66|
|Utilization review for asthma, %||57.6||80.0||41.2||0.003|
|Clinical case management program for asthma, %||21.1||29.2||15.2||0.20|
|Home visits as part of asthma management, %||11.9||16.0||8.8||0.40|
|Community-based asthma screening, %||12.1||12.5||11.8||0.930|
|Community-based adult asthma education programs, %||20.7||29.2||14.7||0.18|
|Community-based pediatric asthma education programs, %||20.7||29.2||14.7||0.18|
|School-based asthma education programs, %||22.4||29.2||17.7||0.30|
Figure 1. Community-based programs for asthma among Chi-cago-area hospitals (n = 59).