scholarly journals Role of social deprivation on asthma care quality among a cohort of children in US community health centres

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e045131
Author(s):  
Jennifer A Lucas ◽  
Miguel Marino ◽  
Katie Fankhauser ◽  
Andrew Bazemore ◽  
Sophia Giebultowicz ◽  
...  
Keyword(s):  
Community Health ◽  
Social Deprivation ◽  
Asthma Severity ◽  
Care Quality ◽  
Problem List ◽  
Asthma Care ◽  
Deprived Neighbourhoods ◽  
The Social ◽  
Neighbourhood Level ◽  
Children With Asthma

ObjectiveSocial deprivation is associated with worse asthma outcomes. The Social Deprivation Index is a composite measure of social determinants of health used to identify neighbourhood-level disadvantage in healthcare. Our objective was to determine if higher neighbourhood-level social deprivation is associated with documented asthma care quality measures among children treated at community health centres (CHCs).Methods (setting, participants, outcome measures)We used data from CHCs in 15 states in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). The sample included 34 266 children with asthma from 2008 to 2017, aged 3–17 living in neighbourhoods with differing levels of social deprivation measured using quartiles of the Social Deprivation Index score. We conducted logistic regression to examine the odds of problem list documentation of asthma and asthma severity, and negative binomial regression for rates of albuterol, inhaled steroid and oral steroid prescription adjusted for patient-level covariates.ResultsChildren from the most deprived neighbourhoods had increased rates of albuterol (rate ratio (RR)=1.22, 95% CI 1.13 to 1.32) compared with those in the least deprived neighbourhoods, while the point estimate for inhaled steroids was higher, but fell just short of significance at the alpha=0.05 level (RR=1.16, 95% CI 0.99 to 1.34). We did not observe community-level differences in problem list documentation of asthma or asthma severity.ConclusionsHigher neighbourhood-level social deprivation was associated with more albuterol and inhaled steroid prescriptions among children with asthma, while problem list documentation of asthma and asthma severity varied little across neighbourhoods with differing deprivation scores. While the homogeneity of the CHC safety net setting studied may mitigate variation in diagnosis and documentation of asthma, enhanced clinician awareness of differences in community risk could help target paediatric patients at risk of lower quality asthma care.

scholarly journals Ventilation heterogeneity in children with severe asthma

2021 ◽  
Author(s):  
Amy G. Nuttall ◽  
Caroline S. Beardsmore ◽  
Erol A. Gaillard
Keyword(s):  
Severe Asthma ◽  
Airway Disease ◽  
Asthma Severity ◽  
Small Airway ◽  
Cross Sectional ◽  
Lung Clearance ◽  
Moderate Asthma ◽  
Lung Clearance Index ◽  
Children With Asthma ◽  
Ventilation Heterogeneity

AbstractSmall airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5–16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV1z-score.Conclusion: VH is present in asthmatic children and appears to be more common in severe asthma. The LCI was significantly higher in the cohort of children with severe asthma, despite no difference in FEV1 between the groups. This supports previous evidence that LCI is a more sensitive marker of airway disease than FEV1. MBNW shows potential as a useful tool to assess children with severe asthma and may help inform clinical decisions. What is Known:• Increased ventilation heterogeneity is present in some children with asthma• Spirometry is not sensitive enough to detect small airway involvement in asthma What is New• Lung clearance index is abnormal in a significant subgroup of children with severe asthma but rarely in children with mild-moderate asthma• Our data suggests that LCI monitoring should be considered in children with severe asthma

scholarly journals Mobility and social deprivation on primary care utilisation among paediatric patients with asthma

2021 ◽  
Vol 9 (3) ◽  
pp. e001085
Author(s):  
Jennifer A Lucas ◽  
Miguel Marino ◽  
Sophia Giebultowicz ◽  
Katie Fankhauser ◽  
Shakira F Suglia ◽  
...  
Keyword(s):  
Primary Care ◽  
Influenza Vaccination ◽  
Negative Binomial ◽  
Social Deprivation ◽  
Pneumococcal Vaccination ◽  
Negative Binomial Regression ◽  
High Deprivation ◽  
Care Utilisation ◽  
Binomial Regression ◽  
Children With Asthma

ObjectiveAsthma care is negatively impacted by neighbourhood social and environmental factors, and moving is associated with undesirable asthma outcomes. However, little is known about how movement into and living in areas of high deprivation relate to primary care use. We examined associations between neighbourhood characteristics, mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting.DesignIn this cohort study, we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.SettingWe used data from community health centres in 15 OCHIN states.ParticipantsThe sample included 23 773 children with asthma aged 3–17 across neighbourhoods with different levels of social deprivation from 2012 to 2017. We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.ResultsClinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation (rate ratio (RR) 1.09, 95% CI 1.02 to 1.17; RR 1.05, 95% CI 1.00 to 1.11). Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination (RR 1.13, 95% CI 1.03 to 1.23) than those who moved but stayed in neighbourhoods of low deprivation.ConclusionsMovement into and living within areas of high deprivation is associated with more primary care use, and presumably greater opportunity to reduce undesirable asthma outcomes. These results highlight the need to attend to patient movement in primary care visits, and increase neighbourhood-targeted population management to improve equity and care for children with asthma.

scholarly journals Utilization and effects of mobile electronic clinical decision support on pediatric asthma care quality in the emergency department and inpatient setting

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Ellen Kerns ◽  
Russell McCulloh ◽  
Sarah Fouquet ◽  
Corrie McDaniel ◽  
Lynda Ken ◽  
...  
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Pediatric Asthma ◽  
Clinical Decision ◽  
Care Quality ◽  
Asthma Care ◽  
Mixed Effect ◽  
National Quality ◽  
Electronic Clinical Decision Support

Abstract Objective To determine utilization and impacts of a mobile electronic clinical decision support (mECDS) on pediatric asthma care quality in emergency department and inpatient settings. Methods We conducted an observational study of a mECDS tool that was deployed as part of a multi-dimensional, national quality improvement (QI) project focused on pediatric asthma. We quantified mECDS utilization using cumulative screen views over the study period in the city in which each participating site was located. We determined associations between mECDS utilization and pediatric asthma quality metrics using mixed-effect logistic regression models (adjusted for time, site characteristics, site-level QI project engagement, and patient characteristics). Results The tool was offered to clinicians at 75 sites and used on 286 devices; cumulative screen views were 4191. Children’s hospitals and sites with greater QI project engagement had higher cumulative mECDS utilization. Cumulative mECDS utilization was associated with significantly reduced odds of hospital admission (OR: 0.95, 95% CI: 0.92–0.98) and higher odds of caregiver referral to smoking cessation resources (OR: 1.08, 95% CI: 1.01–1.16). Discussion We linked mECDS utilization to clinical outcomes using a national sample and controlling for important confounders (secular trends, patient case mix, and concomitant QI efforts). We found mECDS utilization was associated with improvements in multiple measures of pediatric asthma care quality. Conclusion mECDS has the potential to overcome barriers to dissemination and improve care on a broad scale. Important areas of future work include improving mECDS uptake/utilization, linking clinicians’ mECDS usage to clinical practice, and studying mECDS’s impacts on other common pediatric conditions.

scholarly journals Using point-of-sale data to examine tobacco pricing across neighbourhoods in Scotland

2020 ◽  
pp. tobaccocontrol-2019-055484 ◽  
Author(s):  
Niamh K Shortt ◽  
Helena Tunstall ◽  
Richard Mitchell ◽  
Emma Coombes ◽  
Andy Jones ◽  
...  
Keyword(s):  
Purchase Price ◽  
Retail Outlet ◽  
Point Of Sale ◽  
Deprived Neighbourhoods ◽  
Convenience Stores ◽  
Neighbourhood Level ◽  
Outlet Density ◽  
Urban Rural ◽  
Multivariable Regression ◽  
Total Sales

ObjectivesTo assess the geographical variation in tobacco price (cigarettes and roll-your-own (RYO) tobacco) in convenience stores across Scotland and how this relates to neighbourhood income deprivation, tobacco retail outlet density and urban/rural status.MethodsTobacco price data from 124 566 shopping baskets purchased in 274 convenience stores during 1 week in April 2018 were obtained through an electronic point-of-sale system. These data were combined with neighbourhood-level measures of income deprivation, tobacco retail outlet density and urban/rural status. We examined brand price for 12 of the most popular cigarette brands and 3 RYO brands and variations in purchases by price segment; multivariable regression analysis assessed associations between area variables and tobacco price.ResultsMost stores sold tobacco in all price segments. The lowest priced subvalue brands were the most popular in all neighbourhoods but were most dominant in shops in more deprived neighbourhoods. When total sales were assessed, overall purchase price varied significantly by neighbourhood income deprivation; packets of 20 cigarettes were 50 pence (5.6%) lower and RYO 34 pence (2.7%) lower among shops in the two highest income deprivation quintiles relative to the lowest. Analysis of individual brands showed that for 3 of the 12 cigarette brands considered, average prices were 12–17 pence lower in more deprived neighbourhoods with the most popular RYO brand 15 pence lower. There was limited evidence of a relationship with tobacco retail outlet density.ConclusionAcross Scottish convenience stores, the purchase price of cigarettes and RYO was lower in more income-deprived neighbourhoods. The lower prices primarily reflect greater sales of cheap brands in these areas, rather than retailers reducing the prices of individual brands.

Evaluation of New York State's Child Health Plus: Children Who Have Asthma

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_E1) ◽  
pp. 719-727 ◽  
Author(s):  
Peter G. Szilagyi ◽  
Jane L. Holl ◽  
Lance E. Rodewald ◽  
Lorrie Yoos ◽  
Jack Zwanziger ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Quality Of Care ◽  
Health Insurance ◽  
Acute Asthma ◽  
Insurance Coverage ◽  
Asthma Severity ◽  
Asthma Care ◽  
Uninsured Children

Background. Little is known about the impact of providing health insurance to uninsured children who have asthma or other chronic diseases. Objectives. To evaluate the association between health insurance and the utilization of health care and the quality of care among children who have asthma. Design. Before-and-during study of children for a 1-year period before and a 1-year period immediately after enrollment in a state-funded health insurance plan. Intervention. In 1991 New York State implemented Child Health Plus (CHPlus), a health insurance program providing ambulatory and ED (ED), but not hospitalization coverage for children 0 to 12.99 years old whose family incomes were below 222% of the federal poverty level and who were not enrolled in Medicaid. Subjects. A total of 187 children (2–12.99 years old) who had asthma and enrolled in CHPlus between November 1, 1991 and August 1, 1993. Main Outcome Measures. Rates of primary care visits (preventive, acute, asthma-specific), ED visits, hospitalizations, number of specialists seen, and quality of care measures (parent reports of the effect of CHPlus on quality of asthma care, and rates of recommended asthma therapies). The effect of CHPlus was assessed by comparing outcome measures for each child for the year before versus the year after CHPlus enrollment, controlling for age, insurance coverage before CHPlus, and asthma severity. Data Ascertainment. Parent telephone interviews and medical chart reviews at primary care offices, EDs, and public health clinics. Main Results. Visit rates to primary care providers were significantly higher during CHPlus compared with before CHPlus for chronic illness care (.995 visits before CHPlus vs 1.34 visits per year during CHPlus), follow-up visits (.86 visits vs 1.32 visits per year), total visits (5.69 visits vs 7.11 visits per year), and for acute asthma exacerbations (.61 visits vs 0.84 visits per year). There were no significant associations between CHPlus coverage and ED visits or hospitalizations, although specialty utilization increased (30% vs 40%; P = .02). According to parents, CHPlus reduced asthma severity for 55% of children (no change in severity for 44% and worsening severity for 1%). Similarly, CHPlus was reported to have improved overall health status for 45% of children (no change in 53% and worse in 1%), primarily attributable to coverage for office visits and asthma medications. CHPlus was associated with more asthma tune-up visits (48% before CHPlus vs 63% during CHPlus). There was no statistically significant effect of CHPlus on several other quality of care measures such as follow-up after acute exacerbations, receipt of influenza vaccination, or use of bronchodilators or antiinflammatory medications. Conclusions. Health insurance for uninsured children who have asthma helped overcome financial barriers that prevented children from receiving care for acute asthma exacerbations and for chronic asthma care. Health insurance was associated with increased utilization of primary care for asthma and improved parent perception of quality of care and asthma severity, but not with some quality indicators. Although more intensive interventions beyond health insurance are needed to optimize quality of asthma care, health insurance coverage substantially improves the health care for children who have asthma.

POLICY IMPLEMENTATION OF A HEALTHY INDONESIA PROGRAM WITH A FAMILY APPROACH IN BANDUNG DISTRICT

2021 ◽  
Vol 8 (3) ◽  
pp. 143-155
Author(s):  
Uri Zaenuri ◽  
Ria Arifianti ◽  
Ratna Meisya Dai
Keyword(s):  
Policy Implementation ◽  
Community Health ◽  
Community Health Center ◽  
Health Sector ◽  
Training Methods ◽  
Implementation Model ◽  
Family Approach ◽  
The Social ◽  
Healthy Family ◽  
Policy Measures

The purpose of this study was to determine the implementation of the Healthy Indonesia Program with a Family Approach which is indispensable as a determinant of the success of the Bandung Regency Government's performance in the health sector. The Healthy Indonesia Program with a Family Approach is a priority program of the Ministry of Health which is implemented by the Center for Community Health. The implementation of the Healthy Indonesia Program with a Family Approach in Bandung Regency was only carried out in 2017 with program socialization activities at the Health Office and Community Health Center levels. The research method used is descriptive qualitative with the approach of Donald van Meter and Carl van Horn's policy implementation model. The findings from the implementation of the Healthy Indonesia Program with a Family Approach in Bandung Regency have been implemented but have not yet reached the target of total coverage. The Bandung Regency Healthy Family Index is included in the unhealthy assessment (<0.8). So that the success of implementation will be achieved when making improvements from deficiencies, both in terms of standards and policy targets or policy measures and objectives, resources, characteristics of the implementing organization, attitudes of the implementers, communication between organizations and implementing activities, and the social, economic and political environment. Suggestions from this study are to improve the empowerment of family roles and community potential with training methods for community cadres, continue the enumerator recruitment program to assist with home visits and data collection and data input, advocate for budget allocations sourced from regional revenue and expenditure budgets.

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