Quality of Inpatient Care for Asthma: Challenges and Opportunities

Evidence-based guidelines for the management of asthma have been available for almost 2 decades. Despite the existence of guidelines and attempts to disseminate them, there remains a significant gap between accepted practices for asthma care and actual practice. The gap is widest in low-income urban communities where asthma morbidity is greatest.1 Quality improvement initiatives have been designed to change the behavior of patients or their caretakers or health care providers. Asthma education and self-management programs aimed at patients and their families have achieved varying degrees of success in improving asthma outcome.2 Changing provider behavior has proved more difficult. Lectures, continuing medical education programs, and industry-sponsored detailing have not had a major impact on changing practice.3 Multifaceted clinician education interventions with feedback are more likely to achieve positive results.4,5 An essential part of this process is to evaluate the quality of care. There is little information on quality of care for children hospitalized for asthma. As detailed in the November issue of Pediatrics , Nkoy et … Address correspondence to Meyer Kattan, MD, CM, Columbia University Medical Center, Pediatric Pulmonary Division, CHC 7-701, 3959 Broadway, New York, NY 10032. E-mail: mk2833{at}columbia.edu