Browsing by Author "Kam, Karen"

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    A Multidisciplinary Clinic for Children with Problematic Severe Asthma: Assessment of Clinical Outcomes, Healthcare Utilization and Costs
    (2014-12-24) Kam, Karen; Currie, Gillian; Nettel-Aguirre, Alberto
    Background: The Intensive Management of Asthma Clinic (IMAC) at the Alberta Children’s Hospital is a novel multidisciplinary clinic for children with severe problematic asthma. Whether consolidating resources in this clinic is effective, compared to the regular asthma clinic, has not been studied. Methods: This quasi-experimental retrospective study compared the IMAC and regular asthma clinic. Data was collected in three categories: clinical outcomes, healthcare utilization, and costs (healthcare utilization, patient-borne). Primary analyses used linear mixed effects modeling, paired t-tests, and ANOVA. Results: Lung function improved more for IMAC patients. Quality of life scores, measured only in the IMAC, improved. Scheduled clinic visits increased, while ED visits decreased. The increased cost of the IMAC was greater than the total costs saved by subsequent decreased healthcare utilization; overall the IMAC was more expensive. Conclusion: The IMAC is effective in improving clinical outcomes and decreasing healthcare utilization; however, these benefits come at extra cost.
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    Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence
    (2015-01-01) Kam, Karen; McKay, Meghan; MacLean, Joanna; Witmans, Manisha B; Spier, Sheldon; Mitchell, Ian
    BACKGROUND: Newborns with Pierre Robin sequence (PRS) often experience chronic intermittent hypoxemia/hypoventilation associated with airway obstruction. The heterogeneity of the severity of upper airway obstruction makes management a challenge; the optimal intervention in individual cases is not clear.OBJECTIVE: To investigate the prevalence of surgical/nonsurgical interventions for PRS at two children’s hospitals. Patient characteristics and outcomes were examined.METHODS: The present retrospective chart review identified 139 patients with PRS born between 2000 and 2010. Demographic information, mode of airway management, associated anomalies and syndromes, polysomnography results, length of intensive care unit and hospital stay, complications and deaths were extracted.RESULTS: Interventions included prone positioning (alone [61%]), tongue-lip adhesion (45%), nasopharyngeal intubation (28%), continuous positive airway pressure (20%), tracheostomy (19%) and mandibular distraction osteogenesis (5%). Tracheostomies were more prevalent in syndromic patients (P=0.03). Patients who underwent tracheostomy had a lower birth weight (P=0.03) compared with newborns with other interventions. Patients who underwent surgical interventions had longer intensive care unit stays (Pud_less_than0.001). No intervention was associated with a statistically significant likelihood of requiring a subsequent intervention. Thirty percent of patients underwent polysomnography, with a higher proportion of these using continuous positive airway pressure (n=15) (Pud_less_than0.01).CONCLUSIONS: In the present descriptive study, patients with syndromic PRS or low birth weight underwent early intervention, which included a tracheostomy. Objective measures of airway obstruction were underutilized. Decision making regarding evaluation and management of upper airway obstruction in this population remains clinician and resource dependent. Reporting data obtained from a large cohort of PRS patients is important to compare experiences and motivate future studies investigating this complex condition.