ABSTRACT
OBJECTIVE: To evaluate the efficacy of a comprehensive asthma program on emergency department (ED) visits and hospital admission rates in an inner-city pediatric population. DESIGN: A12-month prospective randomized trial. METHODS: Three hundred asthma patients, ages 2 to 17 years, were recruited and randomized in an inner-city pediatric ED, to obtain asthma care in a specialty clinic or to continue receiving care by other health resources. The specialty clinic provided intensive medical and environmental control, education, close monitoring, and 24-hour availability. For the prospective study, monthly questionnaires were sent to the caregivers of these children to evaluate use of hospital facilities for asthma care. For the retrospective study, use of hospital resources by the study participants was analyzed using a hospital database. RESULTS: One hundred twenty-nine patients (60 in the treatment group and 69 in the control group) were included in the final analysis. Asthma severity index was significantly higher for the patients in the treatment versus the control group (35% versus 16.2%, P = .05). Fewer patients in the treatment group visited the ED at least once during the first study year, 32 versus 46, (P = .11), and they made fewer visits, 73 versus 269. The mean number of ED visits of the patients who used the ED was 0.1 versus 0.326 for the control group (P = .01). There were also fewer admissions in the treatment group, 22 versus 29 (P < .59). The 53 patients remaining in the treatment group in the second study year made fewer visits to the ED versus the control group (P < .03). In comparison to the first year, fewer patients in the treatment group visited the ED or were hospitalized in the second year (P = .007 and P = .04, respectively). CONCLUSIONS: A comprehensive asthma care program is efficacious in reducing hospital utilization.
Subject(s)
Asthma/therapy , Comprehensive Health Care/organization & administration , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Outpatient Clinics, Hospital/organization & administration , Adolescent , Child , Child, Preschool , Health Education , Hospitals, Urban , Humans , New York City , Severity of Illness Index , Utilization ReviewABSTRACT
OBJECTIVE: The purpose of this study was to examine fetal chromosomal abnormalities in pregnancies complicated by unexplained elevated maternal serum alpha-fetoprotein (MSAFP). STUDY DESIGN: We reviewed, using a computerized database, 58,162 obstetrical ultrasounds that were performed for various indications. Fetuses with MSAFP multiples of the median (MOM) > or = 2.5 and normal extensive ultrasounds were identified. Maternal demographic data and fetal karyotype were obtained. RESULTS: Seven hundred eighty-nine patients received ultrasounds for evaluation of elevated MSAFP. Of the 595 patients with normal scans, 195 (32.8%) underwent amniocentesis and cytogenetic evaluation. Two chromosomal abnormalities were detected (1.0%), including an inversion and a balanced translocation. CONCLUSION: The two karyotypic abnormalities identified in our study consisted of structural rearrangements. Patients undergoing karyotype analysis for unexplained elevated MSAFP should be counseled that the types of aneuploidy detected under this circumstance differ from those associated with advanced age and specific fetal anomalies (trisomy and triploidy).