Integrated care facilitation model reduces use of hospital resources by patients with pediatric asthma.

This evaluation assessed a model of care for pediatric asthma patients that aimed to promote health and reduce their preventable and avoidable use of acute hospital services. Pediatric asthma patients (n=223) were allocated care facilitators who provided assistance in the promotion of carer/self-management, education and linkage to an integrated healthcare system, comprising of acute and community-based healthcare providers. Patients' use of acute hospital services (emergency department [ED] presentations, admissions, and bed-days) pre- and postrecruitment were compared using Wilcoxon signed rank tests. The pediatric asthma care givers quality of life questionnaire' was used to assess changes in health and quality of life. The patients displayed a 57% reduction in ED presentations, 74% in admissions, and a 71% reduction in bed-days. Whereas a comparator group displayed 27%, 32%, and 14% increases, respectively. Patients also reported significant improvements in quality of life domains of activity limitation (+5.6, p<.001) and emotional function (+9.1, p<.001). The reduction in the use of hospital services was attributed to the aversion of preventable presentations and admissions, via the enhancement of carer/self-management and access to community health services. These outcomes were supported by indicators of improved patient health and quality of life, and comments by the participant's carers.

Developmental assessment of children: a survey of Australian and New Zealand paediatricians.

OBJECTIVES: To determine the current practice for developmental assessment of children by Australian and New Zealand paediatricians. To determine factors associated with higher levels of self-reported confidence and expertise in developmental paediatrics and factors associated with better practice. METHODS: A cross-sectional postal survey of Australian and New Zealand paediatricians conducted in 2003, enquiring about their training in developmental paediatrics and their practice for evaluating development. RESULTS: Of 811 questionnaires sent, 590 (73%) were returned. Ninety-one respondents indicated that they did not see children with developmental issues leaving 499 surveys for analysis. The overwhelming majority of paediatricians felt that more training was required in developmental paediatrics (88%) and that there was a need to be taught a formal developmental assessment tool (83%). Higher self-ratings of confidence and expertise in developmental paediatrics were associated with a period of formal developmental training (OR (95% CI) 2.7 (1.6-4.4), 3.4 (2.0-5.8), respectively), and being taught a formal developmental assessment tool (OR (95% CI) 2.0 (1.2-3.2), 2.2 (1.3-3.7), respectively). Predictors of paediatricians performing a formal developmental assessment included formal developmental training (OR (95% CI) 2.0 (1.1-3.8)) being taught an assessment tool (OR (95% CI) 2.8 (1.5-5.2)) and mandatory training (OR (95% CI) 2.4 (1.4-4.1)). CONCLUSIONS: Developmental paediatrics is a significant and important part of paediatric practice. This survey suggests, however, that paediatric training and continuing education should have not reflected this practice. The overall method and content of developmental training including whether formal assessment tools should be taught needs to be reviewed and revised.