Follow-Up After Asthma Emergency Department Visits and Its Relationship With Subsequent Asthma-Related Utilization

Naomi S. Bardach, Valerie S. Harder, Charles E. McCulloch, Robert Thombley, Judith S. Shaw, Victoria C. Hart, Michael D. Cabana

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: To assess the association between follow-up after an asthma-related emergency department (ED) visit and the likelihood of subsequent asthma-related ED utilization. Methods: Using data from California Medicaid (2014–2016), and Vermont (2014–2016) and Massachusetts (2013–2015) all-payer claims databases, we identified asthma-related ED visits for patients ages 3 to 21. Follow-up was defined as a visit within 14 days with a primary care provider or an asthma specialist. Outcome: asthma-related ED revisit after the initial ED visit. Models included logistic regression to assess the relationship between 14-day follow-up and the outcome at 60 and 365 days, and mixed-effects negative binomial regression to assess the relationship between 14-day follow-up and repeated outcome events (# ED revisits/100 child-years). All models accounted for zip-code level clustering. Results: There were 90,267 ED visits, of which 22.6% had 14-day follow-up. Patients with follow-up were younger and more likely to have commercial insurance, complex chronic conditions, and evidence of prior asthma. 14-day follow-up was associated with decreased subsequent asthma-related ED revisits at 60 days (5.7% versus 6.4%, P < .001) and at 365 days (25.0% versus 28.3%, P < 0.001). Similarly, 14-day follow-up was associated with a decrease in the rate of repeated subsequent ED revisits (66.7 versus 77.3 revisits/100 child-years; P < 0.001). Conclusions: We found a protective association between outpatient 14-day follow-up and asthma-related ED revisits. This may reflect improved asthma control as providers follow the NHLBI guideline stepwise approach. Our findings highlight an opportunity for improvement, with only 22.6% of those with asthma-related ED visits having 14-day follow-up.

Original languageEnglish (US)
Pages (from-to)S125-S132
JournalAcademic Pediatrics
Volume22
Issue number3
DOIs
StatePublished - Apr 2022

Keywords

  • access
  • asthma
  • emergency department
  • follow-up
  • quality measurement
  • utilization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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