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Quality of Care and Outcomes of Adults With Asthma Treated by Specialists and Generalists in Managed Care
Albert W. Wu, MD, MPH;
Yuchi Young, DrPH;
Elizabeth A. Skinner, MSW;
Gregory B. Diette, MD, MHS;
Michael Huber, BA;
Alan Peres, BA;
Donald Steinwachs, PhD
Arch Intern Med. 2001;161:2554-2560.
Background The growth of managed health care in the United States has been accompanied
by controls on access to specialty physician services. We examined the relationship
of physician specialty to treatment and outcomes of patients with asthma in
managed care plans.
Methods We conducted a mail survey of adult asthma patients who were enrolled
in 12 managed care organizations and had at least 2 contacts for asthma (International Classification of Diseases, Ninth Revision, Clinical
Modification code 493.x) during the previous 24 months; we also surveyed
their treating physicians. This report concerns 1954 patients and their 1078
corresponding physicians. Treatment indicators included use of corticosteroid
inhalers, use of peak flow meters, allergy evaluation, discussion of triggers,
and patient self-management knowledge. Outcome measures included canceled
activities, hospitalization or emergency department visits, asthma attacks,
workdays lost, asthma symptoms, physical and mental health, overall satisfaction
with asthma care, and satisfaction with communication with physicians and
nurses.
Results Significant differences were noted for patients of specialists and experienced
generalists compared with those of generalist physicians. Peak flow meter
possession was reported by 41.9% of patients of generalists, 51.7% of patients
of experienced generalists, and 53.8% of patients of pulmonologists or allergists.
Compared with patients of generalists, outcomes were significantly better
for patients of allergists with regard to canceled activities, hospitalizations
and emergency department visits for asthma, quality of care ratings, and physical
functioning. Patients of pulmonologists were more likely to rate improvement
in symptoms as very good or excellent.
Conclusions In a managed health care setting, physicians' specialty training and
self-reported expertise in treating asthma were related to better patient-reported
care and outcomes.
From the Health Services Research and Development Center, Department
of Health Policy and Management (Drs Wu, Young, and Steinwachs and Ms Skinner),
and the Department of Epidemiology (Drs Wu and Diette), School of Hygiene
and Public Health, and the Department of Medicine, School of Medicine (Drs
Wu, Diette and Steinwachs), The Johns Hopkins University, Baltimore, Md; and
the Managed Health Care Association Outcomes Management System Consortium,
Washington, DC (Mssrs Huber and Peres).
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