ASTHMA SURVEILLANCE IN DC

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

A complete report from 2002 - 2006 is available for download.

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 over 15 million school days. Asthma is also 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:

Like inner-city children with asthma elsewhere, pediatric patients in DC depend heavily on EDs for episodic acute care of acute exacerbations, and like elsewhere, their rates of follow-up with primary care providers (PCPs) after acute exacerbations is extremely low, less than 20%. Data from our own studies is again illustrative. Parents of over 60% of a sample of 488 patients with asthma seen in the ED at Children’s National Medical Center (CNMC) 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. Our data reveals that more than 50% of our patient sample made 3 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, over two thirds are made by children under 9 years of age:

and the vast majority are made by children in the most disadvantaged areas of the District: