Case management and quality assurance to improve care of inner-city children with asthma
L. S. Wissow, M. Warshow, J. Box and D. Baker
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore.
Case management and quality assurance techniques were used in a program
designed to improve the process and outcomes of care for inner-city
children with asthma. The program had three major elements: assessment of
the care of individual patients and feedback to their primary care
providers, periodic contact with parents, and provision of educational
materials about asthma to parents. Telephone interviews with parents were
used to assess knowledge of home asthma care and the type of care
prescribed by the child's physician. Medicaid and hospital records were
used to measure acute care utilization. Eighty-eight children (aged 0 to 5
years) who had made more than two emergency room visits for asthma were
recruited by telephone. Fifty-six prescribing errors were identified, 24
being failure to prescribe an additional drug for short-term use by
children receiving continuous therapy. Acute care use dropped 50% compared
with a control period. This type of program is feasible but may require
in-person recruiting to reach high-risk families without telephones.
