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K B Weiss

Publications and source records attributed to K B Weiss.

At least 55 records · Page 3Linked to original sources
PubMed1998

Burden of wheezing illness among U.S. children reported by parents not to have asthma.

We examined the 12-month prevalence of asthma and wheezing among U.S. children and compared the illness-related burden of children who wheezed with and without an asthma diagnosis. Data were obtained in a cross-sectional telephone survey that tested the performance of a health interview designed to identify children with chronic health conditions. Respondents were 712 primary caretakers of 1388 children under 18 years old in a national probability sample selected by random-digit dialing. Although 51 children identified with asthma and wheezing had more episodes, sleep disturbances, and attacks that limited speech, and received more medical treatment for wheezing than 69 children with wheezing alone, the "undiagnosed" children appeared to be only somewhat less affected by their wheezing. Repeat episodes and burden experienced by children with wheezing alone suggest that the asthma prevalence may be underestimated if based only on the diagnostic label.

Adolescent↗
PubMed1996

National Asthma Education and Prevention Program working group report on the financing of asthma care.

The financing of asthma care is the third topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group explored the effects of financing on access to services, treatment of asthma, and potential health outcomes. Over the course of a year, the working group collected and analyzed information pertaining to the various types of public and private health care financing mechanisms, including both insurance-based and non-insurance-based issues. The group examined the published literature and gathered information from four public hearings conducted across the nation. The result of this synthesis of information on health care financing and asthma care is a set of 12 recommendations that seek to improve the financing of asthma care.

Asthma↗
PubMed1996

National Asthma Education and Prevention Program working group report on the cost effectiveness of asthma care.

The cost effectiveness of asthma care is the first topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group characterized the role of health economics in understanding optimal asthma management strategies. The report first reviews methods for economic evaluation of medical technologies, with a particular focus on cost-effectiveness analysis. Next, the report explores the nature and usefulness of several key asthma outcome measures, including clinical and symptom measures, measures of lung function, measures of functional status, and measures of health services utilization and cost. The working group also conducted a review of the literature on cost effectiveness of asthma patient education programs, pharmaceutical therapy, and a variety of alternative and adjunct interventions. The report concludes with recommendations for a standardized approach for economic evaluation study designs (e.g., common asthma outcomes, long-term follow-up, and studies with patients of different ages, socioeconomic statuses, and severity levels) and for an expansion in the number of such standardized asthma studies and cost-effectiveness analyses.

Asthma↗
PubMed1996

National Asthma Education and Prevention Program working group report on the quality of asthma care.

The quality of asthma care is the second topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group recommended an asthma continuous quality improvement model as an appropriate framework for examining the quality of asthma care. This model can be implemented by various organizations and providers of care in a variety of settings. The framework consists of four steps: (1) define the opportunity for improvement, (2) set the asthma quality improvement goals (outcomes), (3) characterize the process of care, and (4) begin the improvement cycle. Several case studies are presented to illustrate the use of this model in various settings, including managed care facilities, emergency departments, teaching hospitals, physician's offices, schools, workplaces, and communities. In addition, the appendix provides an overview of asthma outcome measures in the framework of patient-centered versus organizationally based perspectives.

Asthma↗
PubMed1995

U.S. hospital care for HIV-infected persons and the role of public and private teaching hospitals: 1988-1991.

Hospitals are a major provider of resources for individuals with HIV-related conditions. With the changing nature of HIV, tracking the dependence on and impact of related care delivered in these institutions is critical to monitoring overall resource need. This report documents HIV inpatient care in U.S. hospitals during 1991 by surveying 1,931 acute care institutions (19% of all acute care institutions). In addition, this report documents changes in HIV care in 124 teaching hospitals between 1988 and 1991. Of the 1,081 hospitals completing the 1991 survey (56%), 773 reported treating at least one HIV inpatient and a total of 58,211 inpatients. Northeastern and public hospitals provided significantly more care. Public-related payer sources financed almost 90% of care in public institutions and > 60% in private institutions. Hospitals reported an average loss of $ 92,025 and an estimated total cost-based loss of $ 71.1 million among all responding institutions. The number of HIV inpatients increased 68% between 1988 and 1991. During these years, substantial increases in revenue and modest reductions in per patient use led to a decrease in total inpatient losses of $ 540,748 to $ 260,331 per hospital. Results show that HIV-associated inpatient care is extensive and increasing and that support for care has become a predominantly public sector responsibility. Teaching hospitals' increase in care suggests that they have become "magnets" for patients with HIV-related disease. However, treatment economies and reimbursement rate improvements have worked to lower losses. Any HIV financing policies should work to balance support for non-hospital care with the continuing need for inpatient treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Pediatric asthma care in US emergency departments. Current practice in the context of the National Institutes of Health guidelines.

OBJECTIVES: To determine whether US emergency department care for pediatric asthma conforms to the National Institutes of Health guidelines and whether the guidelines are likely to be adopted in clinical practice. DESIGN: Mail survey conducted from January to April 1992, and stratified by hospital type (children's, public and community). SETTINGS: Emergency departments of US hospitals. PARTICIPANTS: Simple stratified random sample of emergency department directors from 376 sampled hospitals. MEASUREMENTS: Self-reported data on emergency department pediatric asthma care, and knowledge and attitudes about the National Institutes of Health guidelines. Data are reported as mean (+/- SE). RESULTS: Sixty-eight percent of the surveyed emergency department directors responded. During 1991, there were an estimated 1.6 million visits for pediatric asthma care. Asthma accounted for 16.9% (+/- 9.0%) of all pediatric emergency department visits. Only 2.1% (+/- 1.0%) reported the use of written protocols or guidelines, with significant variation by hospital type. Sixty-seven percent (+/- 3.0%) reported the use of pulse oximetry. Eighty percent reported the use of beta-agonists by inhalation as the initial treatment. Only 44.7% (+/- 2.9%) reported the use of steroids if there was a poor response to the initial treatment. An estimated 45.5% (+/- 3.9%) of respondents had heard of the guidelines at the time of this survey; approximately 24% reported that they had read the guidelines. Most respondents reported that the guidelines were credible, clear and concise, and likely to be adopted in their emergency department. CONCLUSIONS: These data suggest that reported pediatric asthma care in US emergency departments differs substantially from the National Institutes of Health guidelines, with considerable variation by hospital type. The guidelines appear to provide an acceptable tool for emergency departments to use in assessing their pediatric asthma care. However, in light of the lack of evidence that the guidelines will improve outcomes, the impact of national guideline adoption remains unclear.

Asthma↗
PubMed1994

Socio-economic burden of asthma, allergy, and other atopic illnesses.

Asthma and atopic illness account for a substantial burden of social morbidity. The purpose of this brief report will be to provide an overview of the different dimensions to the socio-economic burden of asthma and other atopic diseases and suggest areas where future research in this area may advance our understanding of the impact of various treatment strategies of these diseases. While there are occasional studies which describe the full dimensions of this social and economic burden, more studies are needed to complete our understanding of this burden especially studies that investigate the relative cost-effectiveness of medical and non-medical interventions. These studies will provide the infrastructure to rationally examine the optimal cost-effective strategies for these illnesses. In particular economic studies are needed to examine how best to balance resource expenditures for preventive versus pharmacologic control. Use of health economic methods will provide insights into the most efficient design and implementation of current disease control, with potentially concomitant reductions in costs and social burden for atopic illnesses, including asthma.

Asthma↗
PubMed1994

An estimate of the prevalence of asthma and wheezing among inner-city children.

OBJECTIVE: To estimate the prevalence of asthma and wheezing unassociated with a diagnosis of asthma among inner-city children. DESIGN: Cross-sectional survey of a sample of Bronx households. METHODS: Random digit dialing telephone survey using parental report. SETTING: Bronx County, NY. PARTICIPANTS: 662 self-designated heads-of-household who reported for all children 0 through 17 years of age living in their households. MEASUREMENTS: Questions from the Child Health Supplement to the 1988 National Health Interview Survey and the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire were used to estimate the prevalence of asthma and wheezing-related illness. RESULTS: Information was gathered on 1285 children. Of this sample, 184 (14.3%) were reported to have ever had asthma (cumulative prevalence) and 111 (8.6%) were reported to have asthma in the last 12 months (period prevalence). The asthma period prevalence rate among Bronx children was twice the United States rate (4.3%). Among children 0 through 11 years of age, the prevalence rate was similar for boys and girls, although among children 12 through 17 years of age, asthma was significantly more prevalent among boys. Fifty-four children (4.2%) were reported to have had wheezing in the past 12 months unassociated with a diagnosis of asthma (wheeze only). The cumulative, but not the period, prevalence rate of asthma differed significantly by income and race/ethnicity. The cumulative prevalence was significantly higher among Hispanics and children from the lowest income families. The prevalence of wheeze only (no reported history of asthma) was higher among whites (6.4%) and blacks (5.8%) than Hispanics (2.9%) (P < .1). The reported number of wheezing attacks and the average number of nights per week that sleep was disturbed by wheezing during the past year were similar for those with asthma and those with wheeze only, although severe attacks (wheezing severe enough to limit speech) were significantly more likely among those reported to have asthma (P < .001). The total asthma prevalence (period prevalence of asthma plus wheeze only) was 12.8% and was quite consistent across subgroups. CONCLUSIONS: These data suggest that the prevalence of asthma among inner-city children may be substantially higher than the rates for this group estimated from national survey data. Some proportion of the wheeze only group may represent undiagnosed, and thereby undertreated, asthma. Public health efforts directed at reducing asthma morbidity and mortality need to address the possibility that asthma prevalence is higher within inner cities and that a large number of children with asthma may be inadequately diagnosed and treated.

Adolescent↗
PubMed1993

Examining issues in health care delivery for asthma. Background and workshop overview.

There have been recent increases in asthma prevalence, morbidity, and mortality in the United States. There is substantial evidence that problems in health care delivery may be contributing to these recent trends. Because of these recent changes, a reduction in asthma-related morbidity has been identified as a new national health objective for the year 2000. This article reviews some of the key aspects of patterns of asthma care in the United States, presents an overview of issues that may play a prominent role in the delivery of care, and provides an overview of the organization of the workshop.

Asthma↗
PubMed1993

Assessing cost-effectiveness in asthma care: building an economic model to study the impact of alternative intervention strategies.

Expenditures for medical care services continue to rise as a proportion of the total Gross Domestic Product (GDP) in most countries. Because a large share of resources are increasingly being spent on medical care services, there is a need to more closely examine the quality, cost and efficiency of all aspects of health care delivery. One method for assessing efficiency is cost-effectiveness analysis. Many of the elements of a basic cost-effectiveness model for asthma care are available, including accepted relevant studies on societal cost-of-illness, accepted health outcomes relevant to good clinical care, and a selection of potential intervention strategies, both for prevention and control. The purpose of this paper is to illustrate how an economic approach to decision-making can be used to assess the potential impact of alternative intervention strategies for asthma care. Two case studies are developed including a new management strategy for the chronic care of stable moderate asthma and a management strategy for the early detection and prevention of childhood asthma. It is proposed that economic modeling of possible intervention strategies can serve as a useful method for determining the potential impact (in terms of cost-effectiveness) of a proposed intervention strategy well in advance of any empiric clinical trials. Analysis such as these may prove valuable in protecting researchers from developing intervention strategies that are clinically efficacious but cost-ineffective and, therefore, are unlikely to be adopted by providers/payers of medical care services for asthmatics.

Asthma↗