Effect of Physician AsthmaEducation on Health Care Utilizationof Children at Different IncomeLevels
Randall Brown, Noreen Clark, Niko Kaciroti,Molly Gong, Michael Cabana, Juanita Lyons
University of Michigan
Funded by NHLBI Grant #HL44976
May 2002
Background
This is a substudy of a randomly controlledtrial to assess patient outcomes resultingfrom asthma care education for theirphysicians.
The education was an interactive seminardesigned to enhance physicians’therapeutic skills in treating children withasthma and to develop their capacity toeducate and counsel families about asthmaself-management.
Purpose
The purpose of this substudy was toexamine program effect on hospitaladmissions and emergency departmentvisits among children of different incomelevels.
Methods
Data Collection
• Patients’ telephone interview:
• Data was collected at baseline, within a 22-month window following the first visit to theirphysician subsequent to the seminar, and 12months thereafter.
Samples
Physician Characteristics
Gender
Female
40%
Male
60%
Age
40-49
37%
30-39
27%
50-59
27%
60 andolder
14%
Patient Characteristics
Girls
30%
Gender
Girls
30%
AfricanAmerican
15%
Race/Ethnicity
Patient Characteristics
> College
14%
HighSchool
22%
HouseholdIncome
20-40 K
22%
40-60 K
20%
60-80 K
19%
> 80 K
19%
< 20 K
20%
HighSchool
22%
> College
14%
< HighSchool
22%
Parent EducationLevel
Data Analysis
Technique
Models were derived from Poissonregressions with generalized estimatedequation (GEE) analyses covering threeperiods: baseline to 12-months, 12 to 24-months, and baseline to 24 months.
Parameters
Previous response regarding the outcomevariables of interest and prior and currentinhaled anti-inflammatory medication usewere controlled in each model.
An interaction (program participation xincome, coded as levels 1 to 11 from low tohigh mean = 7.1), and programparticipation were included to examine ifthe effect of the intervention differedaccording to income level.
The Model
Number of ED/Hospitalizations at Follow-up 1 orFollow-up 2
+ Baseline score or first Follow-up score
+ Program participation
+ Income
+ Inhaled medication use at Baseline
+ Inhaled medication use at Follow-up 1 orFollow-up 2
+ Interaction term of program participation xincome
Results
Table 1. Adjusted Yearly Rate of Hospitalizations forFamilies of Different Income Levels
* Yearly rates were calculated using the following formulae:
Yearly rate = ek x 365
k = intercept + b1 x mean Baseline or Follow-up 1 score + b2 x programparticipation + b3 x income + b4 x medication use + b5 x interaction of income xprogram participation
Table 2. Adjusted Yearly Rate of ED Visits for Familiesof Different Income Levels
* Yearly rates were calculated using the following formulae:
Yearly rate = ek x 365
k = intercept + b1 x mean Baseline or Follow-up 1 score + b2 x programparticipation + b3 x income + b4 x medication use + b5 x interaction of income xprogram participation
Results
Results
Table 3. Estimates and p-values for Program Participation and Interaction ofProgram Participation and Income
Baseline to Follow-up 1
* Regardless of family income, the effects of physician education onhealth care utilization were not revealed from Baseline to Follow-up 1.
Results
Table 4. Estimates and p-values for Program Participation and Interaction ofProgram Participation and Income
Follow-up 1 to Follow-up 2
* Regardless of family income, children whose physicians were in theintervention group had significantly fewer hospital admissions fromFollow-up 1 to Follow-up 2.
** The education for physicians was significantly effective in reducing EDvisits for lower income children from Follow-up 1 to Follow-up 2.
Results
Table 5. Estimates and p-values for Program Participation and Interaction ofProgram Participation and Income
Baseline to Follow-up 2
* Regardless of family income, children whose physicians were in theintervention group showed a strong trend toward fewer hospitaladmissions from Baseline to Follow-up 2.
** The education for physicians was effective in reducing ED visits atlower income levels from Baseline to Follow-up 2.
Conclusions
1. The education interactive seminar for physiciansdid not effect hospital admissions and ED visits fromBaseline to Follow-up 1.
2. Regardless of family income, the interactiveseminar for physicians reduced hospital admissionsfrom Follow-up 1 to Follow-up 2 and from Baselineto Final Evaluation.
3. The program effect on ED visits from Follow-up 1to Follow-up 2 was found only in children whosefamily income was less than $20,000.