Barbara Morray

Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study

BackgroundAdvances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a childrens hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.MethodsChart review of 100 randomly selected patients from all services discharged from a childrens hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD.ResultsAmong the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0–13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases.ConclusionTechnology-dependency is common among children discharged from a childrens hospital.

The Asthma Outreach Project: A Promising Approach to Comprehensive Asthma Management

We describe a pilot system of coordinated asthma care emphasizing home visits by a community-based lay worker collaborating with a pediatrician, pharmacist, and public health nurse. Study participants included 23 low-income children with moderate to severe asthma and their families at an inner-city pediatric clinic. This system was successfully implemented, and client satisfaction was extremely high. Utilization review showed a reduction in hospitalizations, emergency department visits, and unscheduled clinic visits, and an increase in follow-up clinic visits. This model of care may reduce unscheduled service use and deserves further study as an alternative for asthma management among similar patient populations.

The Impact of Asthma and Asthma-Like Illness in Seattle School Children

The impact of asthma and asthma-like illness was measured in a population of 5-9-year-old Seattle public school children. Child health information was obtained from a survey of 1665 parents of first and second grade students to assess medical services use and impaired physical functioning among diagnosed asthmatics and those with current wheezing, defined as wheezing in the past 12 months without a diagnosis of asthma, relative to an asymptomatic population with neither condition. Relative to the asymptomatic population, the prevalence of respiratory-related activity limitation, and perception of poorer child health was larger among diagnosed asthmatics than children with current wheezing. However, the prevalence of sleep disturbances, school absences, medical services use, and parental concern over their childs health was similar for both the asthmatic and wheezing groups relative to the asymptomatic group. Also, in both symptomatic groups, a history of moderate or severe wheezing was associated with an increased prevalence of respiratory-related sleep disturbances and activity limitation. The similarity between the impact of diagnosed asthma and undiagnosed asthma-like illness suggests that the overall social and economic burden of asthma may be higher than previously estimated.

Differences in asthma prevalence between samples of American Indian and Alaska native children

OBJECTIVES To better understand the prevalence of asthma among American Indian and Alaska Native (AI/AN) children and to explore the contribution of locale to asthma symptoms and diagnostic assignment, the authors surveyed AI/AN middle school students, comparing responses from metropolitan Tacoma, Washington (metro WA) and a non-metropolitan area of Alaska (non-metro AK). METHODS Students in grades 6-9 completed an asthma screening survey. The authors compared self-reported rates of asthma symptoms, asthma diagnoses, and health care utilization for 147 children ages 11-16 self-reporting as AI/AN in metro WA and 365 in non-metro AK. RESULTS The prevalences of self-reported asthma symptoms were similar for the metro WA and non-metro AK populations, but a significantly higher percentage of metro WA than of non-metro AK respondents reported having received a physician diagnosis of asthma (OR 2.33; 95% CI 1.23, 4.39). The percentages of respondents who reported having visited a medical provider for asthma-like symptoms in the previous year did not differ. CONCLUSIONS The difference in rates of asthma diagnosis despite similar rates of asthma symptoms and respiratory-related medical visits may reflect differences in respiratory disease patterns, diagnostic labeling practices, or environmental factors. Future attempts to describe asthma prevalence should consider the potential contribution of non-biologic factors such as diagnostic practices.

Prevalence of Asthma and Respiratory Symptoms among Alaskan Native Children♦ 1966

The prevalence of asthma among children has increased in the last decade, particularly among ethnic minorities. However, the prevalence of asthma and other respiratory conditions among Alaskan native children has not been previously reported. Children attending grades 6-9 in three villages in the Yukon-Kuskokwim delta region of Alaska were surveyed in 1997 using modified validated instruments developed by the International Studies of Asthma and Allergies in Children (ISAAC). Children were categorized as those who had received a diagnosis of asthma by a doctor, children with asthma-like symptoms without a diagnosis of asthma, children with daily sputum production without asthma-like symptoms, and normal children without respiratory symptoms. The proportions of children (as% of total children surveyed/village) in each category are depicted below. The frequency of different respiratory symptoms varies among villages. Yet, in all three sites asthma symptoms are more common than diagnosed asthma. Daily sputum production suggestive of chronic bronchitis is more common than both diagnosed and undiagnosed asthma. Remarkably, more than half of middle school children in Southwest Alaska by self-reporting have chronic respiratory symptoms. Table