Management of Acute Asthma in Pediatric Practice (MAAPP). Abstract, ExecutiveSummary, Final Report and Appendices A-C

摘要

The National Heart, Lung, and Blood Institute (NHLB)/National Asthma EducationProgram and the American Academy of Pediatrics (AAP), have both published and disseminated detailed guidelines for asthma care. This major effort in shaping treatment strategies has occurred without knowledge of current asthma care practices, extent of varibility in care, and the relationship of management variability to patient outcomes. The primary purpose of this project was to determine the range of variability in pediatric office-based management of acute asthma, how this management differed from the national guidelines, and whether variability in care affected short-term clinical outcomes. Over a 12 month period, 55 community-based providers from the AAP's Pediatric Research in Office Settings (PROS) Network, recruited from 26 PROS practices from 17 states, recorded information on clinical findings and management plans for 363 consecutive children (aged 4-17 years) presenting to their offices with an acute exacerbation of asthma. Parents completed one questionnaire at enrollment and another 5-7 days after the initial clinical encounter to document short-term clinical and functional outcome. The results of the study documented that, in many aspects of acute asthma care, pediatric providers generally followed national guideline recommendations, especially with regard to using B-agonist medication and providing careful follow-up for patients during an acute asthma exacerbation. However, providers varied substantially from guidelines in some areas of evaluation and management notably for patients with a moderate to severe presentation. Variations in care were found to be related to certain patient and provider characteristics and had a modest impact on clinical outcome.