Health care education, delivery, and qualityAchieving and maintaining asthma control in an urban pediatric disease management program: The Breathmobile Program
Section snippets
Study population
This observational study evaluates patterns of asthma control in a treated population of pediatric patients whose families follow-up with ongoing care in a guideline-based disease management program. The treated population reflects a self-selected group that participates when (1) ongoing specialty care is offered to the general population of children at many sites across an urban lower socioeconomic community, (2) financial and logistical barriers are minimized, and (3) systematic approaches
Patient population
Ages ranged from 3 to 18 years (mean, 9 years; SD, 3.4 years) at the time of the first visit and included a predominately Hispanic (self-described) population with patients in all guideline severity classifications. The characteristics of the patients considered for the time-to-control and maintenance-of-control analyses are described in Table I.
Patient visit intervals
Seventy percent of visits occurred within 71 days of the previous visit. The average interval between patient visits to the program was a median of 56
Discussion
This study reports patterns of asthma control observed in the context of a systematic approach to regularly scheduled care for a large, lower socioeconomic, urban pediatric population. The results provide a novel view of the ability to achieve and maintain control of asthma (as determined by an asthma specialist) when families in this setting elect to participate in readily accessible guideline-based care. Although the number of visits required to achieve control was greater for children
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The Los Angeles County Department of Health Services provides ongoing support for all clinical operations. The Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA) has provided start-up funds for each Breathmobile, ongoing technical support for the Asma-Trax clinical tracking system, and ongoing support for data management and data analysis. AAFA has received funds to support the data management and analysis from Genentech and Merck, Inc. Schools as sites for ongoing care, nursing services as part of the health care team, and electrical power to support Breathmobile operations are provided by the Los Angeles Unified School District and the Montebello Unified School District. Development of the first-generation clinical tracking software was supported in part by the Southern California AAFA, GlaxoSmithKline, and Merck, Inc. Support for development of the current clinical tracking system, Asma-Trax, was provided in part by the Southern California AAFA.
Disclosure of potential conflict of interest: C. A. Jones has consulting arrangements with AstraZeneca, Genentech, Merck, and Sanofi-Aventis; has received grant support from Genentech, GlaxoSmithKline, and Merck; and is on the speakers' bureau for AstraZeneca, Genentech, Merck, and Sanofi-Aventis. K. Y. C. Kwong has received grant support from GlaxoSmithKline and is on the speakers' bureau for Novartis, Genentech, and AstraZeneca. The rest of the authors have declared that they have no conflict of interest.