A multidisciplinary clinic for pediatric patients with problematic severe asthma: Impact on clinical outcomes and healthcare utilization
Bibliographic record
Abstract
BACKGROUND: The Intensive Management of Asthma Clinic (IMAC) is a novel multidisciplinary clinic for children with problematic severe asthma. Whether consolidating resources in this clinic is effective in improving clinical outcomes and reducing unscheduled healthcare visits has not been studied.METHODS: This retrospective, observational cohort study compared the IMAC and regular asthma clinic at a pediatric quaternary care hospital over a 4-year period. Clinical outcomes (forced expiratory volume in 1 second [FEV1], number of oral steroid days, and short-acting beta-agonist [SABA] refills), and healthcare utilization and its costs (number of clinic visits, emergency department [ED] visits, hospitalizations) were collected. Linear mixed effects modeling was used to account for repeated measurements grouped into 3-month time intervals.RESULTS: Mean FEV1 was higher for IMAC patients by 4.6 (CI 1.1 to 8.1, p = 0.01) throughout the study period. Scheduled clinic visits were higher by 0.2 (CI 0.1 to 0.3, p < 0.01) on average in any 3-month time interval, while ED visits decreased by 0.1 (CI −0.2 to −0.1, p < 0.01) over time for the IMAC group. Hospitalizations decreased over time by 0.03 (CI −0.05 to −0.02, p < 0.01) for both groups. The increased cost of the IMAC was greater than total costs saved by subsequent decreased healthcare utilization.CONCLUSION: The increase in planned clinic visits for the IMAC group was associated with fewer unplanned ED visits. A multidisciplinary clinic for children with severe asthma can lead to decreased acute care utilization; however, these benefits may come at extra cost. Studies such as this enable decision-makers to judge whether the benefits of multidisciplinary clinics are worth the additional resources required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".