• G B Diette, E A Skinner, L E Markson, P Algatt-Bergstrom, T T Nguyen, R D Clark, and A W Wu.
• Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
• J. Pediatr. 2001 Jan 1;138(1):59-64.

ObjectiveTo evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines.DesignCross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity.ResultsOf 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing.ConclusionsThere are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist.

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