Easy Breathing© Continues to Reduce Medical Services Utilization for Urban Children with Asthma. Michelle M. Cloutier, Dorothy B. Wakefield, Howard Bailit, Charles B. Hall. University of Connecticut Health Center, Farmington, CT, Connecticut Children's Medical Center, Hartford, CT and Albert Einstein College of Medicine, Bronx, NY.

Easy Breathing©, an asthma management program for urban children began in June 1998. The program adapts NHLBI-NAEPP guidelines for use by primary care providers in busy urban primary care clinics. We examined hospital days, emergency room visits, outpatient visits (OPD) and the corticosteroid to bronchodilator ratio (C/B) in children enrolled in Easy Breathing between 07/01/98-12/21/98 and in children with asthma (by ICD-9 diagnosis) not enrolled in the program. Data are reported for one full year before (Pre) and 2 full years after (1 Yr Post, 2 Yr Post) enrollment (Table).

Easy Breathing© has decreased hospital days and outpatient visits for children with asthma and has increased inhaled corticosteroid use. Reductions in ED use have been modest. The improvements have been sustained over 2 years.

Research supported by the Patrick and Catherine Donaghue Medical Research Fdn.

EASY BREATHING© AND PROVIDER ADAPTIVE PERCEPTIONS. SJ Macary, DB Wakefield, PS Carlisle, H Bailit, MM Cloutier. University of Connecticut Health Center and Connecticut Children's Medical Center, Hartford, CT.

Easy Breathing© (EzB) is a pediatric asthma management program, based on the NHLBI-NAEPP Guidelines, that is used by all six urban, primary care clinics in Hartford. While EzB has improved adherence to these Guidelines, less than 25% of Hartford children have been enrolled in EzB over the past 3 years. The relationship between the number of completed EzB surveys, surrogate marker of adherence to the Guidelines, and asthma-related, provider self-efficacy, outcome expectancy, and knowledge was examined to determine potential factors associated with variance in provider participation. Of 47 distributed surveys, 29 (62%) were returned (18 from physicians; 11 from mid-level practitioners. Irrespective of clinic, mid-level practitioner scores reflected greater self-efficacy, outcome expectancy, and knowledge than physician scores (self-efficacy: p=0.02; outcome expectancy: p =0.005; knowledge: p=0.02). Although surveys were completed anonymously, 19 respondents signed their names. Self-efficacy scores for these individuals were subsequently linked to the number of EzB surveys they had completed. Increases in the number of completed surveys were associated with greater self-efficacy (r =0.76). The association between the number of completed surveys and outcome expectancy scores (r =0.50) and knowledge scores (r =0.45) was not as strong. Our results are consistent with the literature suggesting that self-efficacy is a good predictor of health related behavior change. Our results also suggest that provider self-efficacy is a major contributor to the implementation of EzB. Programs to increase provider self-efficacy may be effective in improving provider adherence to disease management programs.

Patrick & Catherine Weldon Donaghue Medical Research Fdn.

ORGANIZATIONAL CULTURE AFFECTS IMPLEMENTATION OF A PEDIATRIC ASTHMA MANAGEMENT PROGRAM. PS Higgins, DB Wakefield, H Bailit & MM Cloutier. Dept of Pediatrics University of Connecticut School of Medicine & Connecticut Children's Medical Center Farmington, CT.

Less than 20% of primary care providers adhere to national asthma guidelines. We have hypothesized that provider self-efficacy and the organizational culture of the practice predict success at implementing disease management programs. As part of an asthma management program for primary care providers, called Easy Breathing II, we conducted a cross-sectional study to investigate organizational culture and successful program implementation as determined by the number of Easy Breathing surveys distributed by 10 practices. Program implementation varied from practices that distributed a survey to every patient presenting for care, to practices that distributed less than 10 surveys. Using a previously validated Organizational Culture Survey completed by practice staff, and an Organizational Attributes Survey completed by the investigators independently, we determined the organizational culture in practices. Contrary to previous reports, practices categorized as hierarchical/rational (those that emphasize efficiency, achievement, and regulations) distributed a significantly higher number of surveys during program start-up (p<.0001), compared to practices categorized as group/development (those that emphasize teamwork, coordination, and change). The correlation between the organizational attribute scale score and the number of surveys distributed identified a significant association (p<.05), between favorable organizational attributes and survey distribution. Our data suggest that organizational culture and attributes might be useful at predicting the success in implementing asthma management programs in primary care settings.

Agency for Health Care Research & Quality

THE EASY BREATHING II SURVEY IMPROVES DIAGNOSIS OF PEDIATRIC ASTHMA IN PRIVATE PRACTICES. V. Hinckson, PS Higgins, DB Wakefield, S. Delaronde, MM Cloutier. Dept. of Pediatrics. University of Connecticut Health Center, Connecticut Children's Medical Ctr and ConnectiCare. Farmington, CT.

Asthma is the most common respiratory disease of children. Under-diagnosis and under-treatment are major causes of morbidity and mortality. Using a previously validated pediatric respiratory survey (Easy Breathing Survey), we characterized asthma prevalence and severity in children cared for at 10 suburban primary care sites. A child was considered to have a new diagnosis of asthma if the parent denied a previous diagnosis and any previous asthma therapy but the provider determined that the child had asthma. In 1291 children who have been surveyed, 26% were diagnosed with asthma. Of these 26%, 86% (278 out of the 324) had self-reported asthma that was subsequently physician-confirmed while 14% (46 children) had previously unrecognized (new diagnosis) asthma. Of the 46 newly diagnosed children 76% had mild, intermittent asthma, 20% had mild, persistent asthma and 4% had moderate, persistent asthma. Of children with asthma, 66% were males and 65% were between 5 and 15 years of age. Children with newly diagnosed asthma did not differ in asthma severity, number of hospitalizations, gender and ethnicity compared to children with previously diagnosed asthma. However, children with previously diagnosed asthma did report a higher number of emergency room and acute office visits (p<0.01). These data suggest that even in the primary care setting, asthma is under-diagnosed and that in this group, children with previously undiagnosed asthma are indistinguishable from children with previously diagnosed asthma.