Abstract
The practice of pediatrics is dynamic and evolving at a rapid pace. In addition to important advances in the basic sciences and pharmacology, pediatric clinicians are broadening their scope—learning to identify practice gaps and effective strategies to implement changes in physician performance to bring about positive changes in patient outcomes.
In this issue of Pediatric Allergy, Immunology, and Pulmonology, we highlight two important articles that discuss topics of importance from Healthy People 2020. Specifically, Healthy People 2020 has set goals for children with asthma—to reduce the number of hospitalizations and emergency department visits, decrease the number of missed school days, and increase formal asthma education. In this issue, Lee and Le discuss barriers to physician adherence with the Expert Panel Guidelines (EPR-3) for the Diagnosis and Management of Asthma. They report studies showing poor adherence to evidence-based EPR-3 guidelines in primary care practices with limited numbers of physicians actively engaging in asthma education, utilizing office spirometry, or asking parents about exposure to environmental tobacco smoke. Interventions to change physician behavior through education have been shown to improve adherence to guidelines and are discussed in this article to assist readers to develop effective quality improvement initiatives in their own practices and institutions.
Exposure to environmental tobacco smoke is well known to have multiple health consequences in both children and adults. Yet, many children, including children with asthma, are exposed on a daily basis. Anand and Downs from Indiana University School of Medicine, funded by an AHRQ grant, analyzed data from 16,523 children between the ages of 0 and 11 years using a pediatric computer decision support system. Their study addresses the impact of race and language preference as factors influencing parents' self-reported smoking and smoking cessation rates. Given that there are significant disparities in healthcare outcomes in this population, this study raises important issues for those caring for Hispanic children.
These articles are representative of the practical and useful evidenced-based research and reviews that you will find in this Journal. It is my hope that they will complement the translational and clinical science and will assist you in your practice.