Impact of Physician Asthma Care Education on patient outcomes.

Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma.

Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty.

The clinician-patient partnership paradigm: outcomes associated with physician communication behavior.

Objective: To identify physician communication behaviors associated with perceptions of quality of care and predictive of positive patient outcomes.

Patients And Methods: A total of 452 families seeing 48 pediatricians for a child's asthma participated. Perceptions and health care use were assessed at baseline and after 12 months through interviews and medical records.

Case-mix adjustment for an expanded renal prospective payment system.

Medicare is considering an expansion of the bundle of dialysis-related services to be paid on a prospective basis. Exploratory models were developed to assess the potential limitations of case-mix adjustment for such an expansion. A broad set of patient characteristics explained 11.

Outcomes associated with spirometry for pediatric asthma in a managed care organization.

Background: The National Heart, Lung and Blood Institute asthma guidelines recommend that children with asthma receive spirometry testing "at least every 1 to 2 years to assess the maintenance of airway function."

Objective: The purpose of this work was to describe: (1) how often children with asthma receive spirometry testing, (2) what factors are associated with receipt of spirometry testing, and (3) the impact of spirometry testing on subsequent emergency department visits for asthma.

Methods: We analyzed all pediatric asthma claims data from a university-based managed care organization for a 3-year period (January 2001 to December 2003).

Impact of physician asthma care education on patient outcomes.

Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma.

Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty.

Understanding the basic case-mix adjustment for the composite rate.

In April 2005, Medicare began adjusting payments to dialysis providers for composite-rate services for a limited set of patient characteristics, including age, body surface area, and low body mass index. We present analyses intended to help the end-stage renal disease community understand the empirical reasons behind the new composite-rate basic case-mix adjustment. The U-shaped relationship between age and composite-rate cost that is reflected in the basic case-mix adjustment has generated significant discussion within the end-stage renal disease community.

National trends in bariatric surgery, 1996-2002.

Background: Surgical therapy for the long-term treatment of obesity ("bariatric surgery") in individuals whose body mass index (calculated as weight in kilograms divided by the square of height in meters) is 40 or higher or in those who have significant obesity-related comorbidities and a body mass index of 35 or higher is one of few interventions shown to be effective. Many aspects of recent national bariatric surgery trends are unclear, including the ages of individuals undergoing such procedures and the economic burden borne by public vs private payers.

Hypothesis: Population-adjusted rates of bariatric surgery are rapidly increasing and have economic implications that differ for private vs public payers.

Asking the correct questions to assess asthma symptoms.

A national survey of 896 parents of children with asthma was performed and responses to 2 types of inquiry were compared: global assessment versus specific assessment of symptoms. Almost all parents, 860 (96%), described their child's asthma as under "good control'' when asked a global assessment question. However, 306 (34%)-when asked specific questions-actually described poor asthma control with frequent symptoms.

Limits of the HEDIS criteria in determining asthma severity for children.

Objective: Although the Health Plan Employer Data Information Set (HEDIS) is a common method for evaluating the quality of asthma care, its accuracy in characterizing persistent asthma in children is unknown. The objective of this study was to compare the assessment of asthma severity (persistent vs nonpersistent asthma) using the HEDIS criteria versus clinical criteria using National Heart, Lung, and Blood Institute (NHLBI) guidelines.

Methods: In a cross-sectional study, we analyzed baseline data from interviews with the parents of 896 children who had asthma and participated in a randomized controlled trial.

Parental management of asthma triggers within a child's environment.

Background: Control of environmental precipitants of asthma is an important component of self-management.

Objective: To assess the type and frequency of attempts by families to control environmental precipitants of symptoms and their degree of consistency with current guidelines.

Methods: We analyzed data from a nationwide sample of 896 children (2-12 years) with asthma.

Pediatrician attitudes and practices regarding collaborative asthma education.

Pediatric practices were surveyed in 10 regions of the country to determine physician attitudes and practices regarding approaches to asthma education. Many physician respondents thought that nurses were just as effective as physicians in providing asthma education. In almost all practices a physician was involved; in two thirds of practices, an allied health professional; and in almost half of practices (48%), a registered nurse was involved.

Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking.

Background: Although environmental tobacco smoke is a common trigger for asthma exacerbations in children, pediatricians infrequently counsel parents who smoke to quit. High physician self-efficacy, or self-confidence, in the ability to counsel parents about smoking cessation is associated with increased physician screening and counseling on this topic. However, it is not clear which factors are associated with high physician self-efficacy for counseling, such as previous training in smoking-cessation counseling or number of years in pediatric practice.