An economic evaluation of short-term inpatient rehabilitation for children with severe asthma.
ABSTRACT The cost of asthma care in the United States in 1990 has been estimated to be 6.2 billion dollars. The greatest proportion is due to hospital care.
We report changes in estimated medical charges of 59 children with severe asthma 1 year before inpatient rehabilitation and over a 4-year follow-up period.
Asthma resource use (e.g., hospital, physician, medication) was identified before and after inpatient rehabilitation. Estimated charges were assigned. This was done retrospectively for the 1-year period before rehabilitation, prospectively during rehabilitation, and over a 4-year follow-up period. Patients served as their own controls. There was no control group.
When median asthma resource use 1 year before rehabilitation was compared with that during the first, second, third, and fourth years of follow-up, there was a reduction in median hospitalization and median emergency care. Compared with mean total medical charges the year before rehabilitation, reductions in mean total medical charges were 56.7% at the completion of the first year (excluding charges for rehabilitation), 70.5% at second year, 74.6% at third year, and 77.5% at fourth year. Over the 4-year postrehabilitation period, the discounted cumulative net savings was $29,605. The discounted cumulative net savings surpassed the mean rehabilitation charge during the early months of the fourth year of the postrehabilitation period.
Inpatient rehabilitation was significantly associated with a reduction in estimated total medical charges over a 4-year follow-up period.
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ABSTRACT: Using data from the 1988 National Health Interview Survey, this article presents national estimates of the prevalence and impact of childhood chronic conditions. Proxy responses to a checklist of child health conditions administered for 17,110 children under 18 years of age were used. Conditions were classified as chronic if they were first noticed more than 3 months prior to the interview or if they were the type that would ordinarily be of extended duration, such as arthritis. An estimated 31% of children were affected by chronic conditions. Among these children, highly prevalent conditions included respiratory allergies 9.7 per 100, repeated ear infections 8.3 per 100 and asthma 4.3 per 100. These children can be divided into three groups: 66% with mild conditions that result in little or no bother or activity limitation; 29% with conditions of moderate severity that result in some bother or limitation of activity, but not both; and 5% with severe conditions that cause frequent bother and limitation of activity. The 5% with severe conditions accounted for 19% of physician contacts and 33% of hospital days related to chronic illness. Childhood chronic conditions have highly variable impacts on children's activities and use of health care.American Journal of Public Health 04/1992; 82(3):364-71. · 3.93 Impact Factor
Article: Mortality from asthma, 1979–1984[show abstract] [hide abstract]
ABSTRACT: Review of data from the National Center for Health Statistics to characterize deaths from asthma disclosed increases in rates of death from 1.2 per 100,000 in 1979 to 1.5 in 1983 and 1984. For black subjects, rates of death from asthma increased from 1.8 in 1979 to 2.5 in 1984; for white subjects, from 1.1 in 1979 to 1.4 in 1984. Age-adjusted rates of death from asthma increased from 1.9 in 1979 to 2.8 in 1983 and 2.6 in 1984 for black subjects, and from 0.8 to 1979 to 1.0 in 1984 for white subjects. Rates for other minority groups have been lower than rates for white subjects. A modest increase in prevalence of asthma among black subjects is insufficient to account for their much higher rate of death from asthma. Increases in rates of death have occurred in both metropolitan and nonmetropolitan areas in all regions of the country and in all but a few states. At least half the deaths from asthma have occurred at hospitals: this proportion did not change from 1979 to 1984. Increases in deaths from asthma have occurred in several other countries as well. Other reviews of deaths from asthma have implicated undertreatment and delays in treatment with bronchodilators and adrenal corticosteroids as factors contributing to death. High rates of death among black subjects suggest underutilization or lack of accessibility of health care. The large proportion of deaths that have occurred at hospitals suggests delays or other inadequacies of treatment at hospitals.Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/1988; 82(5):705-717.
- Journal of Allergy and Clinical Immunology 03/1989; 83(2 Pt 1):477-85. · 12.05 Impact Factor