ABSTRACT
OBJECTIVE: To develop and evaluate a set of questionnaire-based screening tools to identify risk for 1-year adverse outcomes in adults with moderate to severe asthma. STUDY DESIGN: Prospective cohort study in 16 managed care organizations in the United States. PATIENTS AND METHODS: Patients (n = 4888) with moderate-to-severe asthma completed baseline and 1-year questionnaires (response rate, 79%). Adverse outcomes included hospitalization in the past year; emergency department (ED) visit in the past year; days of lost activity in the past month; a composite measure combining hospitalization, ED use, and lost days; and severe symptoms. Risk models were constructed for each of these 5 outcomes. Candidate predictors included baseline demographic characteristics, prior asthma healthcare use, access to care, symptoms, and treatment. Outcome variables were dichotomized, and logistic regression analysis was used to estimate the probability of 1-year outcomes. RESULTS: The patients' mean age was 45 years; 69% were female, and 83% were white. At 1-year follow-up, 9% had been hospitalized in the past year, 35% had used the ED, and 36% had reduced activity in the past month; 54% reported at least 1 of these, and 53% reported severe symptoms. Twenty-one items were retained for the 5 final risk models. Overall, the strongest predictors were comorbid illnesses and prior ED use. Model discrimination using receiver operating characteristic area ranged from 0.67 to 0.78 for predicting hospitalization, ED use, lost days, any one of these outcomes, and symptoms. CONCLUSIONS: The questionnaire-based risk models identified with good discrimination asthmatics at increased risk for a range of adverse outcomes. Risk models based on patient-reported data could be used to target individuals for intervention.
Subject(s)
Asthma , Managed Care Programs/organization & administration , Self Disclosure , Treatment Outcome , Adolescent , Adult , Asthma/complications , Asthma/therapy , Cohort Studies , Female , Health Services Accessibility , Health Services Research , Humans , Male , Middle Aged , Risk Adjustment , Surveys and Questionnaires , United StatesABSTRACT
The Asthma Therapy Assessment Questionnaire (ATAQ) for children and adolescents was developed to assist clinicians and health plans to identify children at risk for adverse outcomes of asthma. ATAQ is a brief, 20-item parent-completed questionnaire that generates indicators of potential care problems in several categories, including symptom control, behavior and attitude barriers, self-efficacy barriers, and communication gaps. This paper describes testing of the internal consistency and construct validity of the instrument. A cross-sectional mail survey with telephone follow-up was conducted with parents of 434 children aged 5-17 years being treated for asthma and enrolled in three managed care organizations in the Midwestern and Northeastern United States. ATAQ scales were evaluated using correlations with measures of health status, asthma impact, and healthcare utilization. ATAQ demonstrated good internal consistency and the hypothesized relationships to corresponding measures from existing instruments. Asthma control was significantly associated with measures of physical health, psychosocial health, resource use, and family impact. "Shared decision making," an indicator of patient-provider communication and involvement of the parent and child in developing asthma management plans, was significantly and positively associated with symptoms and parental satisfaction. Other ATAQ components showed similar associations. ATAQ appears to have satisfactory measurement properties and is ready for use to identify patients who might benefit from further disease management efforts or medical attention.
Subject(s)
Asthma/drug therapy , Disease Management , Patient Compliance/psychology , Risk Assessment/methods , Surveys and Questionnaires , Adolescent , Asthma/psychology , Child , Child, Preschool , Cross-Sectional Studies , Female , Health Care Surveys , Humans , Male , Managed Care Programs , Midwestern United States , New England , Self Efficacy , Sickness Impact ProfileABSTRACT
The authors evaluated participation in activity programs in a prospective study of 198 new nursing home admissions. Both on admission and after 1 year, approximately 50% of patients were not participating in activities. Nonparticipation was associated with greater cognitive and functional impairment and the use of restraints and neuroleptics. Over the year, activity status changed for approximately 50% of patients in relation to these factors. These findings indicate current limitations in nursing home activity programs and suggest that participation is a dynamic process influenced by identifiable clinical variables. Revision of activity programs is necessary to meet OBRA regulations to improve the quality of patients' lives.
