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Sheikh SI, Pitts J, Ryan-Wenger NA, Kotha K, McCoy KS, Stukus DR. Improved quality-of-life of caregivers of children with asthma through guideline-based management. J Asthma 2016; 54:768-776. [PMID: 27831828 DOI: 10.1080/02770903.2016.1258077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The quality of life (QOL) of caregivers of children with asthma may be related to children's responses to asthma management. AIM To evaluate change in QOL over time of caregivers of children with asthma through guideline-based management. DESIGN This was a 3-year prospective cohort study of children with asthma referred to our pediatric asthma center. Families completed Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), the Asthma Control Test™ (ACT), and reported the number of days/month of albuterol use and wheezing at each clinic visit. RESULTS We enrolled 143 children, ages 7-17 years (mean = 10.6 ± 2.9), 56.6% male, 70.6% Caucasian. Patients were managed by the same MD (n = 65,45.5%) or APN (n = 78,54.5%) over time. The mean total PACQLQ significantly increased over the 3-year period (F = 67.418, p < .001). Total scores at the first visit were 4.8 ± 1.6, which improved to 6.1 ± 1 at the 3-month follow-up visit. This improvement was sustained at the 1, 2, and 3-year clinic visits. PACQLQ emotional function (F = 60.798, p < .001) and activity limitation (F = 41.517, p < .001) domains significantly improved as well. PACQLQ scores were significantly associated with improved ACT scores (r = .37 to .47, p < .05), fewer days/month of albuterol use (r = -.25 to -.36., p < .05), and wheezing (r = -.28 to -.33, p < .05). There were no significant differences in PACQLQ, or asthma clinical outcome measures between MD and APN providers. CONCLUSION Use of National Asthma Education and Prevention Program (NAEPP) guidelines significantly improved QOL of caregivers of children with asthma and in asthma-related symptoms. Improvements over time were independent of type of providers.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA.,c Section of Allergy & Immunology , Nationwide Children's Hospital , Columbus , OH , USA
| | - Judy Pitts
- b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Nancy A Ryan-Wenger
- b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Kavitha Kotha
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Karen S McCoy
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - David R Stukus
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,c Section of Allergy & Immunology , Nationwide Children's Hospital , Columbus , OH , USA
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Janevic MR, Stoll S, Wilkin M, Song PXK, Baptist A, Lara M, Ramos-Valencia G, Bryant-Stephens T, Persky V, Uyeda K, Lesch JK, Wang W, Malveaux FJ. Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study. Am J Public Health 2016; 106:2012-2018. [PMID: 27631740 DOI: 10.2105/ajph.2016.303373] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of care coordination on asthma outcomes among children in underserved urban communities. METHODS We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical-social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials. RESULTS At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization. CONCLUSIONS Care coordination may improve pediatric asthma symptom control and reduce emergency department visits. POLICY IMPLICATIONS Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.
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Affiliation(s)
- Mary R Janevic
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Shelley Stoll
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Margaret Wilkin
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Peter X K Song
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Alan Baptist
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Marielena Lara
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Gilberto Ramos-Valencia
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Tyra Bryant-Stephens
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Victoria Persky
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Kimberly Uyeda
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Julie Kennedy Lesch
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Wen Wang
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Floyd J Malveaux
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
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