First name
Mitchell
Middle name
G
Last name
Maltenfort

Title

Variability in Diagnosed Asthma in Young Children in a Large Pediatric Primary Care Network.

Year of Publication

2020

Date Published

2020 Feb 07

ISSN Number

1876-2867

Abstract

<p><strong>OBJECTIVES: </strong>Our objectives were to (1) quantify the frequency of wheezing episodes and asthma diagnosis in young children in a large pediatric primary care network and (2) assess the variability in practice-level asthma diagnosis, accounting for common asthma risk factors and comorbidities. We hypothesized that significant variability in practice-level asthma diagnosis rates would remain after adjusting for associated predictors.</p>

<p><strong>METHODS: </strong>We generated a retrospective longitudinal birth cohort of children who visited one of 31 pediatric primary care practices within the first 6 months of life from 1/2005-12/2016. Children were observed for up to 8 years or until the end of the observation window. We used multivariable discrete time survival models to evaluate predictors of asthma diagnosis by 3-month age intervals. We compared unadjusted and adjusted proportions of children diagnosed with asthma by practice.</p>

<p><strong>RESULTS: </strong>Of the 161,502 children in the cohort, 34,578 children (21%) received at least one asthma diagnosis. In multivariable modeling, male gender, minority race/ethnicity, gestational age &lt;34 weeks, allergic rhinitis, food allergy, and prior wheezing episodes were associated with asthma diagnosis. After adjusting for variation in these predictors across practices, the cumulative incidence of asthma diagnosis by practice by age 6 years ranged from 11-47% (interquartile range (IQR): 24-29%).</p>

<p><strong>CONCLUSIONS: </strong>Across pediatric primary care practices, adjusted incidence of asthma diagnosis by age 6 years ranged widely, though variation gauged by the IQR was more modest. Potential sources of practice-level variation, such as differing diagnosis thresholds and labeling of different wheezing phenotypes as "asthma", should be further investigated.</p>

DOI

10.1016/j.acap.2020.02.003

Alternate Title

Acad Pediatr

PMID

32044466

Title

Responsiveness of Children's Global Health to Improvements in Acute Asthma.

Year of Publication

2018

Number of Pages

1-22

Date Published

2018 May 01

ISSN Number

1532-4303

Abstract

<p><strong>OBJECTIVE: </strong>To evaluate the reliability and validity of the PROMIS Pediatric Global Health scale, a 7-item measure of perceived physical, mental, and social health, in children with asthma.</p>

<p><strong>METHODS: </strong>From February 2014 to February 2015, convenience samples of children 8-17 years-old (n = 182) and parents of children 5-17 years-old (n = 328) visiting an emergency department for treatment of asthma were enrolled. The Asthma Control Test was used to characterize children as controlled versus not controlled, and the PROMIS Asthma Impact Scale was used to assess the effects of asthma symptoms on functional status. We conducted longitudinal analyses among 92 children and 218 parents at 3 weeks, and 74 children and 171 parents at 8 weeks after enrollment.</p>

<p><strong>RESULTS: </strong>The PGH-7 reliability across the three time points ranged from 0.66 to 0.81 for child-report and 0.76 to 0.82 for parent-proxy. In cross-sectional analyses, children with controlled asthma had PGH-7 scores 0.40-0.95 standard deviation units higher than those who were uncontrolled. The PGH-7 was responsive to changes in overall general health between time points, with moderate effect sizes (0.5-0.6 standard deviation units). In longitudinal analyses, PGH-7 scores were no different between those who stayed uncontrolled versus became controlled at 3 weeks of follow-up; however, by 8 weeks of follow-up, the differences between these groups was 0.7-0.8 standard deviation units, indicative of large effects.</p>

<p><strong>CONCLUSIONS: </strong>The PGH-7 is a reliable and valid patient-reported outcome for assessing general health among children with asthma. It is a useful complement to other asthma-specific outcome measures.</p>

DOI

10.1080/02770903.2018.1471701

Alternate Title

J Asthma

PMID

29712498

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