Urban Minority Children with Asthma: Substantial Morbidity, Compromised Quality and Access to Specialists, and the Importance of Poverty and Specialty Care

Flores, Glenn; Snowden-Bridon, Christina; Torres, Sylvia; Perez, R. Alamino; Walter, Tim; Brotanek, Jane; Lin, Hua; Tomany-Korman, Sandy

doi:10.1080/02770900802712971

Cited by 137 publications

(85 citation statements)

References 28 publications

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“…Urban children frequently have barriers that limit access to primary care, and thus results are relevant to providers in a variety of settings because each point of contact with the health care system presents a unique opportunity to initiate interventions. [20][21][22] …”

Section: Resultsmentioning

confidence: 99%

“…Bivariate analysis between these 2 groups was first performed to evaluate for differences in factors that have been previously identified as affecting primary outcomes in asthma hospitalizations, which included gender, obesity status, ethnicity, age, asthma severity, and specific comorbidities (prematurity, allergic rhinitis, eczema, atopy, OSA, GER, and ETS exposure). 9,12,14,20,26 The same factors were then evaluated in a bivariate analysis to assess for associations with the primary outcomes. On the basis of these results, a multivariate regression was performed to evaluate for associations between overweight status and primary outcomes using a model controlling for significant cofactors identified in the second bivariate analysis (age, gender, ethnicity, asthma severity, and comorbidities -, Logistic regression analysis was performed evaluating for differences among all listed ethnic groups; P value reflects there was no significant difference across all groups using a logistic regression analysis; BMI percentile: lean, ,85th; overweight, 85th-95th; obese, .95th.…”

Section: Methodsmentioning

confidence: 99%

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Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Aragona

El-Magbri

Wang

et al. 2016

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVE:The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. METHODS:A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean ,85%, overweight 85%-95%, obese $95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. RESULTS:The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (,5 years) were .2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Aragona

El-Magbri

Wang

et al. 2016

Hospital Pediatrics

View full text Add to dashboard Cite

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“…[4][5][6] However, health care providers do not routinely follow asthma guideline recommendations, 7,8 resulting in substandard care and poor health outcomes. [9][10][11][12][13][14] One of the shortcomings of asthma guidelines is the limited extent to which health care providers are provided with tools to follow the recommended care. 15 There have been provider-targeted interventions, [16][17][18][19][20][21] but most interventions have been patient-focused.…”

mentioning

confidence: 99%

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Butz²,

et al. 2013

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BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers' adherence to asthma guidelines on health care process and clinical outcomes. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-forperformance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. METHODS:CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. Pediatrics 2013;132:517-534

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“…Children living in poverty have been shown to have higher utilization of urgent and acute care, lower utilization of primary and specialist care, and higher prevalence of both asthma and obesity. [42][43][44] Even when obesity was recognized in this study, the provider did not always identify it as a discharge diagnosis. At the time of discharge only 5.4% of subjects with overweight or obesity received a diagnosis that indicated overweight or obesity.…”

Section: Discussionmentioning

confidence: 99%

“…[39][40][41][42] Future studies may support stronger recommendations in the NAEPP and Global Initiative for Asthma guidelines related to weight recognition and management in all health care settings and in all age groups for children with asthma. The urban setting and prevalence of government-insured subjects in this study (66.7%) lends support to capitalizing on the opportunity to recognize and treat overweight and obesity in the inpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

Borgmeyer

Ercole²,

Niesen

et al. 2016

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Information is lacking regarding recognition and treatment of overweight and obesity in children hospitalized for asthma. The study objectives were to determine the current practice of recognition, diagnosis, and treatment of overweight and obesity for children hospitalized for asthma and to describe demographic, asthma, and weight characteristics for these patients. METHODS:A retrospective record review was conducted for children admitted to the hospital with asthma in 2012. Charts were reviewed for evidence of recognition, diagnosis, and treatment of overweight and obesity. Subjects were classified into age-adjusted Centers for Disease Control and Prevention weight categories based on BMI percentile and chronic asthma severity categories according to National Asthma Education and Prevention Program guidelines. RESULTS:A total of 510 subjects aged 3 to 17 years were studied. Obesity was present in 19.6% and overweight in 13.3% of subjects. BMI percentile was recorded in only 3.3% of all charts, in only 11% of subjects with obesity, and in 0% of subjects with overweight. BMI percentile was documented more often in subjects with severe obesity (P 5 .013) and with moderate to severe persistent asthma (P 5 .035). Only 9 of 168 subjects who were overweight or obese (5.6%) were given a discharge diagnosis indicating overweight or obesity, and 14 (8.3%) received treatment. Chronic asthma severity differed by BMI weight category (P , .001), with a significant relationship between obesity status and chronic asthma severity in older subjects (P 5 .033). There were no differences in severity of acute episodes based on weight group.CONCLUSIONS: Overweight and obesity were underrecognized, underdiagnosed, and undertreated in children hospitalized for asthma.

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Urban Minority Children with Asthma: Substantial Morbidity, Compromised Quality and Access to Specialists, and the Importance of Poverty and Specialty Care

Cited by 137 publications

References 28 publications

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

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