Asthma Care Practices in Chicago-Area Emergency Departments
Use of emergency departments (EDs) by persons with asthma in various stages of crises is one of the key manifestations of asthma morbidity in the United States and is an important public health concern. In 1995, there were an estimated 1.9 million ED visits for asthma in the United States.
In 1991, the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute published guidelines for the diagnosis and management of asthma.2 These guidelines have been discussed in many settings, including national meetings of the American College of Emergency Physicians and the Society of Academic Emergency Medicine. there
The NAEPP developed an ED kit, including a copy of the guidelines, poster versions of guideline algorithms, a monograph on the role of EDs in managing asthma in a broader public health context, and a supporting letter from the president of the American College of Emergency Physicians and the director of the National Heart, Lung, and Blood Institute (R. Fulwood; personal communication; January, 1996). This kit was distributed to every ED in the country. Additionally, emergency medicine physicians were involved in the process of revising the NAEPP guidelines, released to the public in 1997.
While there has been wide dissemination of these guidelines, there are few studies examining the variations in asthma care practices among EDs. One study, focused on the care of children with asthma in United States EDs, reported significant variations in care and important differences in normative practices compared with the recommendations in the NAEPP guidelines. These studies, while informative, were conducted on large national samples and did little to reveal how asthma-related practice patterns might vary within a single community. The purpose of this study was to characterize how EDs in a large community care for persons with asthma.