Predictors of control over time among poor, inner-city, children with asthma

The 1997 NAEPP Asthma Guidelines state that children, irrespective of severity, should achieve satisfactory control, e.g. minimal current signs and symptoms. This study aims to identify predictors of improvement in Control for children enrolled in a Pediatric Asthma Chronic Care Model (PACCM) trial. Four urban Community Health Centers (CHC) completed a prospective, controlled, year-long trial of the PACCM. PACCM at all sites included an asthma registry, outreach, practitioner education, standardized visit sheet and quarterly asthma visits to primary care practitioners, combined with either web-based, patient linked decision support or group feedback. Control (excellent to very poor) was assessed at each visit and defined as: Excellent Control is the absence of symptoms, Good Control is equivalent to mild intermittent asthma, Fair, Poor and Very Poor Control equate to mild, moderate and severe persistent symptoms, respectively. 196 primarily Hispanic (73%), 10.56 year old males (55%), with baseline Severity of Mild Intermittent (46%), Mild Persistent (31%), Moderate Persistent (21%), Severe Persistent (2%) and baseline Control of Excellent (40%), Good (16%), Fair (17%), Poor (14%) and Very Poor (5%) attended all visits. Repeated measures ANOVA showed that significant predictors of improvement in Control (transformed to an interval scale using Rasch modeling) over time were baseline age (eta 2=0.02), severity (eta 2=0.055) and trigger exposure (eta 2=0.087), feedback type (eta 2=0.039). Irrespective of the kind of practitioner feedback provided, exposure to the Pediatric Asthma Chronic Care Model results in improvement in symptom control even for those children with more severe asthma and exposure to triggers at baseline.