THE CHILDREN'S HEALTH SURVEY FOR ASTHMA (CHSA): A TOOL FOR CLINICAL PRACTICE? L Asmussen, L Olson. Department of Practice and Research, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL. Presented as a poster at the 2000 Pediatric Academic Societies? Annual Meeting.

BACKGROUND: Although the CHSA was originally designed and tested for research purposes, there is growing interest in the field of outcomes research to extend health outcome measures to the clinical setting for use with individual patients to foster education and intervention activities. As the development of practice-based tools for the adult population had advanced quite rapidly, efforts in the pediatric population have not followed suit.

OBJECTIVE: To test the feasibility of the Children's Health Survey for Asthma (CHSA) - Clinical Version for direct patient care in the office setting.

DESIGN/METHODS: Qualitative and quantitative data from 22 families and their health care providers (recruited through the AAP PROS Network) were used to obtain information about the CHSA-Clinical Version (CHSA-CV). Parents completed the questionnaire prior to the medical encounter and providers had an opportunity to review parental responses prior to the visit. The office interaction was audiotaped. A separate debriefing interview with parent and provider regarding use of the questionnaire was completed after the medical visit. All parent respondents were mothers and the majority was Caucasian. Child participants had been previously diagnosed with asthma.

RESULTS: Quantitative results from the pilot reveal good psychometric properties despite small sample size. Mothers provided a range of responses to individual items indicating that the CHSA-CV taps a wide range of asthma experiences. Further, all items were endorsed by at least one parent as being a "problem" area suggesting that the CHSA-CV asks the appropriate questions to address topics of frequent concern to parents of children with asthma. Qualitative data obtained from audiotape transcripts of office interactions suggest that there is room for improvement in the discussion of problematic topics between parent/child and the health care professional. In this study, parents had an opportunity to formally and systematically think about issues of concern and clinicians had an opportunity to review those concerns prior to the patient encounter, yet neither raised many of the problem topics identified by parents. In debriefing interviews, mothers were enthusiastic about being asked the kinds of questions included on the CHSA-CV, not only items pertaining to the child, but also questions about parental worries, concerns and impact on the family. Clinicians, overall, also endorsed use of the CHSA-CV. A comment repeated by several participants was that the measure caused them to think about issues not usually considered.

CONCLUSION: Despite a small sample size, preliminary results suggest that the CHSA-CV may be a useful tool in clinical practice. Parents and providers endorsed use of such a tool and provided good feedback for modifications to enhance the CHSA-CV. Further testing is in planning.