Documentation of asthma control and severity in pediatrics: analysis of national office-based visits

J Asthma. 2020 Feb;57(2):205-216. doi: 10.1080/02770903.2018.1554069. Epub 2019 Jan 18.

Abstract

Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04-2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.

Keywords: Asthma; asthma control; asthma severity; documentation; pediatric; uncontrolled asthma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asthma / epidemiology*
  • Asthma / physiopathology*
  • Child
  • Comorbidity
  • Cross-Sectional Studies
  • Documentation / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Humans
  • Logistic Models
  • Male
  • Odds Ratio
  • Office Visits / statistics & numerical data*
  • Pediatrics / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Residence Characteristics
  • Severity of Illness Index
  • Sinusitis / epidemiology
  • Socioeconomic Factors
  • United States