Dedicated asthma center improves the quality of care and resource utilization for pediatric asthma: a multicenter study.

OBJECTIVES: To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care. METHODS: A retrospective case-control design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12-month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample. RESULTS: Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (> or = 1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 +/- 6.7 days vs 16.6 +/- 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 +/- 2.8 vs 7.4 +/- 4.1; p = 0.03). CONCLUSIONS: Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment.

Effect of education and legislation on bicycle helmet use in a multiracial population.

OBJECTIVE: To observe the effect of new legislation and a boroughwide bicycle helmet educational campaign on bicycle helmet use in a multiracial population. DESIGN: A prospective observational study. Observations were made at randomly selected sites in Queens (study group) and Brooklyn (control group), NY, in May 1994, before a New York State law affecting both boroughs was enacted and before a bicycle helmet educational campaign was conducted in Queens. Variables observed included age, sex, race, and whether the child was wearing a bicycle helmet while riding. A bicycle helmet campaign was conducted in late May 1994. New York State bicycle helmet law was effected on June 1, 1994, requiring all children aged 1 to 14 years to wear helmets while riding their bicycles. Follow-up observations were made at the same sites in July or August 1994. SETTING: Queens County, New York, which is the most racially diverse county in the United States, according to 1990 census data. PARTICIPANTS: Cross-sectional observations of children aged 1 to 14 years made at randomly selected sites. INTERVENTIONS: A boroughwide bicycle helmet educational campaign conducted in May 1994 in Queens. RESULTS: The overall use of helmets increased from 4.7% (13/276) to 13.9% (44/316) (P < .001) in the study group. Helmet use decreased from 5.6% (19/342) to 4.2% (13/312) (P = .10) in the control group during the same period. CONCLUSIONS: In a multiracial population, a statistically significant (P < .001) increase of helmet use was demonstrated after a campaign and distribution of educational material. Legislation alone is inadequate for ensuring increased bicycle helmet use.