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To study variables associated with Emergency Department (ED) utilization among pediatric patients with asthma in a Federally Qualified Health Center (FQHC). We analyzed Electronic Health Record (EHR) data in a retrospective cohort study of patients with asthma between ages 2 and 18 who received primary care at a FQHC. The primary outcome studied was a visit to the ED at Ann and Robert Lurie’s Children’s Hospital (LCH) for an acute visit related to asthma. Univariate analyses and a multiple logistic regression were performed to study the effect of demographic and clinical variables on ED utilization. Of the 286 patients in the initial EHR query, 200 were included in the final analysis. The median age of subjects in the study cohort was 8.73 years. Patients in the cohort with ED visits averaged 1.32 ED visits in the 15-month period of analysis. The multivariable logistic regression model demonstrated the significant predictors of ED utilization were (1) younger age (OR 0.977, 0.968–0.984, P < 0.001), (2) proximity of patient residence to the hospital when compared with their primary care medical home (OR 0.907, 95 % CI 0.828–0.992, P < 0.05), and (3) absence of an asthma action plan (OR 0.079, 95 % CI, 0.016–0.283, P < 0.001). Younger age, closer relative proximity of the patient’s home to the hospital compared with the clinic, and absence of an asthma action plan were all identified as significant predictors of ED utilization. Sex, ethnicity, language, passive smoke exposure, and insurance status were not statistically significant predictors of ED utilization.

The impact of air pollution on fetal growth remains controversial, in part, because studies have been limited to sub-regions of the United States with limited variability. No study has examined air pollution impacts on neonatal health care utilization. We performed descriptive, univariate and multivariable analyses on administrative hospital record data from 222,359 births in the 2000, 2003 and 2006 Kids Inpatient Database linked to air pollution data drawn from the US Environmental Protection Agency’s Aerometric Information Retrieval System. In this study, air pollution exposure during the birth month was estimated based on birth hospital address. Although air pollutants were not individually associated with mean birth weight, a three-pollutant model controlling for hospital characteristics, demographics, and birth month identified 9.3% and 7.2% increases in odds of low birth weight and very low birth weight for each μ g/m 3 increase in PM 2.5 (both P <0.0001). PM 2.5 and NO 2 were associated with −3.0% odds/p.p.m. and +2.5% odds/p.p.b. of preterm birth, respectively (both P <0.0001). A four-pollutant multivariable model indicated a 0.05 days/p.p.m. NO 2 decrease in length of the birth hospitalization ( P =0.0061) and a 0.13 days increase/p.p.m. CO ( P =0.0416). A $1166 increase in per child costs was estimated for the birth hospitalization per p.p.m. CO ( P =0.0002) and $964 per unit increase in O 3 ( P =0.0448). A reduction from the 75th to the 25th percentile in the highest CO quartile for births predicts annual savings of $134.7 million in direct health care costs. In a national, predominantly urban, sample, air pollutant exposures during the month of birth are associated with increased low birth weight and neonatal health care utilization. Further study of this database, with enhanced control for confounding, improved exposure assessment, examination of exposures across multiple time windows in pregnancy, and in the entire national sample, is supported by these initial investigations.

Asthma is a common chronic illness among adults. National guidelines recommend comprehensive implementation of environmental control practices (ECP) for asthma management. The purpose of this study was to examine the association between preventive asthma care and comprehensive ECP use among adults with asthma. We used data from the Four-State National Asthma Survey, including 3727 adults with asthma. Comprehensive management was defined as implementing at least five of eight ECP: (1) air filter, (2) dehumidifier, (3) mattress cover, (4) pillow cover, (5) no pets, (6) no smoking, (7) no carpets, and (8) washing sheets in hot water. We examined the association between comprehensive implementation of ECP and receipt of preventive asthma care, as measured by number of routine asthma visits in the prior year and physician advice to modify the environment. Overall, 13.3% (95% confidence interval [CI], 11.8-14.8%) of participants reported comprehensive ECP use. The most frequently implemented ECP were no smoking (80%), no pets (54%), and washing sheets in hot water (43%). Comprehensive ECP use was associated with having received physician advice (odds ratio [OR], 2.3; 95% CI, 1.6-3.4) and increased number of routine asthma visits (1-2 visits: OR, 2.4, and 95% CI, 1.5-4.0; 3-4 visits: OR, 2.4, and 95% CI, 1.3-4.5; 5 or more visits: OR, 3.4, and 95% CI, 1.9-6.4). Receipt of preventive asthma care is associated with comprehensive implementation of ECP. Further research is needed to determine the factors mediating these associations to develop more effective asthma counseling.

Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5-16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention.

Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5‒16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention. Public Health Implications. Clinically integrated asthma CHW and AE-C services that do not provide home environmental remediation equipment may improve and sustain asthma control.

There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fine-particulate matter are sufficiently protective of children's health. [PUBLICATION ABSTRACT]

Background: Acute exposure to outdoor air pollutants has been associated with increased pediatric asthma morbidity. However, the impact of subchronic exposures is largely unknown. Objective: To examine the association between subchronic exposure to 6 outdoor air pollutants (PM 2.5 , PM 10 , ozone, nitrogen oxides, sulfur oxides, carbon monoxide) and pediatric asthma hospitalization length of stay, charges, and costs. Methods: We linked pediatric asthma hospitalization discharge data from a nationally representative dataset, the 1999-2007 Nationwide Inpatient Sample, with outdoor air pollution data from the Environmental Protection Agency. Hospitals with no air quality data within 10 miles were excluded. Our predictor was the average concentration of 6 pollutants near the hospital during the month of admission. We conducted bivariate analyses using Spearman correlations and multivariable analyses using Poisson regression for length of stay and linear regression for log-transformed charges and costs, controlling for patient demographics, hospital characteristics, and month of admission. Results: In unadjusted analyses, all 6 pollutants had minimal correlation with the 3 outcomes ( ρ<0.1, P<0.001). In multivariable analyses, a 1-unit (μg/m 3 ) increase in monthly PM 2.5 led to a $123 increase in charges (95% confidence interval $40-249) and a $47 increase in costs (95% confidence interval $15-93). No other pollutants were significant predictors of charges or costs or length of stay. Conclusion: Subchronic PM 2.5 exposure is associated with increased costs for pediatric asthma hospitalizations. Policy changes to reduce outdoor subchronic pollutant exposure may lead to improved asthma outcomes and substantial savings in healthcare spending.