Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits

Michael D. Cabana, David Bruckman, Susan L. Bratton, Alex R. Kemper, Noreen M. Clark

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background. The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. Objective. To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. Design. We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from January 1998 to October 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. Results: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. Conclusions. Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.

Original languageEnglish (US)
Pages (from-to)741-749
Number of pages9
JournalJournal of Asthma
Volume40
Issue number7
DOIs
StatePublished - Nov 18 2003
Externally publishedYes

Fingerprint

Hospital Emergency Service
Outpatients
Asthma
Pediatrics
Primary Health Care
National Heart, Lung, and Blood Institute (U.S.)
Managed Care Programs
Survival Analysis
Insurance
Proportional Hazards Models
Cohort Studies
Multivariate Analysis

Keywords

  • Asthma guidelines
  • Emergency department
  • Follow-up
  • Primary care
  • Quality of care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits. / Cabana, Michael D.; Bruckman, David; Bratton, Susan L.; Kemper, Alex R.; Clark, Noreen M.

In: Journal of Asthma, Vol. 40, No. 7, 18.11.2003, p. 741-749.

Research output: Contribution to journalArticle

Cabana, Michael D. ; Bruckman, David ; Bratton, Susan L. ; Kemper, Alex R. ; Clark, Noreen M. / Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits. In: Journal of Asthma. 2003 ; Vol. 40, No. 7. pp. 741-749.
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