183 Abstracts antibiotics increased from 53% to 56% at initial visits for AOM. The increase was statistically significant compared to controls. The increase was greatest among emergency room physicians, while remaining unchanged among family medicine physicians. Characteristics of prescribers who were most responsive to the intervention were further described using multivariate analyses. CONCLUSIONS: The intervention achieved a statistically significant increase of prescription rate of first line antibiotics in the treatment of initial visits for AOM in children after a single mailing, but the magnitude of change was not large. PD3 RELIABILITY AND VALIDITY OF KINDL CHILDREN GENERIC HEALTH-RELATED QUALITY OF LIFE QUESTIONNAIRE IN AN ASIAN SCHOOL-BASED SAMPLE Hwee Lin W, Shu Chuen L National University of Singapore, Singapore, Republic of Singapore OBJECTIVES: To determine the feasibility, validity and reliability of KINDL in an Asian school-based sample. Introduction: KINDL-Kid and KINDL-Kiddo have been culturally adapted and tested in a sample of diabetic and healthy children in Singapore with promising results. Testing of KINDL was extended to a schoolbased sample more representative of the general children population. METHODS: Invitations for participations were sent to all schools in Singapore after permission was obtained from the Ministry of Education. Students aged 8–16 years old from participating schools were randomly selected. After the purpose of the study was explained, the questionnaires were administered and the participants were asked to complete the questionnaire without seeking their friends’ opinions. The students were asked to report if they had any of the chronic conditions such as asthma and diabetes. RESULTS: A total of 328 participants completed KINDL-Kid (mean score: 68.3 ± 12.57%) while 1026 completed KINDL-Kiddo (mean score: 59.3 ± 11.64%). 25 KINDL-Kid and 56 KINDL-Kiddo participants were asthmatics. Majority of participants in both groups were Chinese (KINDL-Kid: 74.1%, KINDLKiddo: 75.2%) and females (KINDL-Kid: 67.0%; and KINDL-Kiddo: 71.5%). The reliability coefficients (Cronbach’s alpha) ranged from 0.4040 to 0.7091 for KINDLKid and 0.3971 to 0.8448 for KINDL-Kiddo. The ceiling effect was significant (>5.0%) in four KINDL-Kid subscales but only one KINDL-Kiddo subscale, while significant flooring effect was observed in one subscale of both instruments. KINDL-Kiddo demonstrated discriminant validity (Healthy vs. Self-reported asthmatics: 56.6 ± 11.92% vs. 51.3 ± 13.21%, p < 0.005) but not KINDLKid (65.5 ± 12.76% vs.66.3 ± 12.71%; p = 0.768). CONCLUSION: The scale reliability obtained suggested a need to re-evaluate the factor structures of KINDL. A factor analysis may be warranted before KINDL is used in Singapore on a large scale. PD4 LONGITUDINAL EXAMINATION OF OUTCOMES ASSOCIATED WITH BOTULINUM TOXIN USE IN CHILDREN WITH CEREBRAL PALSY Balkrishnan R, Camacho F, Smith BP, Koman AL Wake Forest University School of Medicine, Winston-Salem, NC, USA OBJECTIVE: The use of botulinum toxin type A (BTX) in the management of spasticity in childhood CP is increasing. Improvement of physical functioning has been demonstrated in short-term clinical trials, but not in prospective longitudinal studies. We examined both child physical functioning and parent-caregiver related psychosocial outcomes related to this treatment in a longitudinal setting. METHODS: A prospective cohort study with annual follow-ups for 2 years was conducted in 172 children with spastic type of cerebral palsy receiving Botulinum Toxin-A (BTX) injections for spasticity management in a large academic medical center setting. A mixed modeling procedure with baseline status confounder adjustment was used to identify changes in both physical functioning outcomes for the child (using the WEEFIM measure) as well as quality of life of the parent caregiver (using the Stein and Reissman Family Impact Scale) with increasing utilization of BTX injections. RESULTS: Each child received an average of 3 BTX injections each year (range: 1–13). Baseline values of outcome variables indicated poor physical functioning in children and significant quality of life burden on the parent caregiver. The study found that each additional BTX injection administration was associated with a 2.3% improvement in the WEEFIM, compared to average baseline score (p = 0.004). Similarly, the study found an improvement of 1% in the parents overall perception of the severity of the child’s condition Family Impact Scale with each additional BTX injection administration (p = 0.008). This reduced perception of severity was in turn, associated with a decreased family impact score. CONCLUSIONS: These findings suggest that treatment with BTX injections are associated with significant improvements in both physical functioning of the child with cerebral palsy as well as the quality of life of the child’s parent caregiver. SESSION II CARDIOVASCULAR DISEASE II CV5 THE COST OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE FROM A STATE MEDICAID PROGRAM PERSPECTIVE Marton J1, Boulanger L2, Menzin J2, Friedman M2, Dixon D2, Wilson J1 1 Pfizer Inc, New York, NY, USA; 2Boston Health Economics, Inc, Waltham, MA, USA