Specialty Care Improves Outcome in Childhood Asthma

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Abstract
By means of a retrospective cohort analysis, we studied the impact of specialty care on health care costs and clinical outcomes in children with moderate to severe asthma. Fifteen patients with a median age of 9 ± 7 years with at least three emergency department (ED) visits and one hospital admission (HA) for asthma were identified. Patients need to be followed for at least 1 year at the Childhood Asthma Care and Education Center (CACEC) to be eligible for this study. A stepwise approach to treatment was applied according to clinical severity. Follow-up was done quarterly by the asthma management team in coordination with the primary care physician. Pulmonary function parameters, clinical outcomes, and hospital charges were compared before and after referral to the CACEC. A 67% reduction in HA rate per year (p < 0.005) and a 75% reduction in ED utilization per year (p = 0.02) were observed. Pulmonary function tests (PFTs) showed significant improvement. The forced expiratory volume in 1 second (FEV1) increased from 63 to 80% of that predicted (p = 0.0006). In addition, the forced expiratory flow between 25 and 75% of the vital capacity (FEF25-75%), a marker of small airway function, increased from 37 to 47% of the predicted values for age (p = 0.03). The estimated mean hospital charges decreased by $3800 per patient per year after study enrollment. Appropriate referral to asthma specialists leads to an improved clinical outcome, decreased health care expenditures, and improved pulmonary function in children with moderate to severe asthma.