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IMPACT DC - Research

Asthma Surveillance in DC

Since October 2001, IMPACT DC has performed ongoing surveillance of pediatric asthma visits to Emergency Departments (EDs) within the District of Columbia.

Asthma is the most common chronic pediatric medical condition in the United States, affecting up to 9-10 million children who annually make up to 1 million visits to emergency departments (EDs) and miss more than 15 million school days. Asthma is a disease marked by dramatic disparities in outcomes, with poor and minority children bearing a disproportionate share of the overall morbidity. The District of Columbia and other urban centers with large populations of disadvantaged minority residents are particularly severely affected. Data from IMPACT DC’s surveillance of ED visits made by children for asthma care in the District demonstrates a visit rate five times the national rate and nearly ten times the target rate of Healthy People 2010.

Similar to inner-city children with asthma elsewhere, pediatric patients in DC depend heavily on EDs for episodic care of acute exacerbations, and similarly, their rates of follow-up with primary care providers (PCPs) after acute exacerbations is extremely low, less than 20 percent. Data from our own studies is again illustrative. Parents of more than 60 percent of a sample of 488 patients with asthma seen in the ED at Children’s reported that the ED was their usual source of asthma care, not their PCPs. Because EDs do not focus on longitudinal aspects of care (such as education and controller medications), many of these children develop unhealthy patterns of ED recidivism. The data reveal that more than 50 percent of our patient sample made three or more ED visits for acute asthma care in the prior 12 months.

Perhaps most disturbing of all is that this pattern of overdependence on ED care affects the most vulnerable patients in urban areas, the young and disadvantaged. Of ED visits made by children in DC, for example, more than two-thirds are made by children younger than 9 years of age and from the most disadvantaged areas of the District:

Grants and Publications
IMPACT DC gratefully acknowledges the additional unrestricted support of the following organizations.
  • AstraZeneca Corporation
  • Friedman Foundation
  • Genentech Corporation
  • Glaxo Smith Kline Corporation
  • Monaghan Medical Corporation

2001 - 2004 Robert Wood Johnson Foundation 43508, “Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC):
An Emergency Department Collaborative Project.”

2005 - 2008

NIH NIAID NIAID-DAIT-02-11: “Inner City Asthma Consortium.”
2005 - 2006 CDC PO149282. Under DC Government contract: “DC Asthma Surveillance Project.”
2006 - 2008 National Association of Chain Drug Stores Foundation: “Enhanced prescription management for asthma care”
2006 American Academy of Asthma, Allergy, and Immunology from Aventis Corporation: “Emergency Department Demonstration Project.”

Teach SJ, Crain E, Quint D, Hylan M, Joseph JG. Indoor environmental exposures among children with asthma seen in an urban emergency department. Pediatrics 2006;117:S152-S158.

Teach SJ, Guagliardo M, Crain E, Quint D, Joseph JG. Spatial accessibility of primary care pediatric services in an urban environment: association with asthma management and outcomes. Pediatrics 2006;117:S78-S85.

Teach SJ, Crain E, Quint D, Hylan, M, Joseph JG. Improved asthma outcomes in a high morbidity pediatric population: Results of an emergency department-based randomized clinical trial. Archives of Pediatrics and Adolescent Medicine 2006;160: 535-541.

Freishstat RJ, Teach SJ. Understanding genomics: Implications for the treatment of asthma. Pediatric Emergency Care 2006;22:71-76.
IMPACT DC - Research - Departments & Programs - Children's National Medical Center