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Rehospitalization of children with asthma
C S Minkovitz1, J S Andrews, J R Serwint
1Department of Population and Family Health Sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Insights
Asthma readmissions in children are not linked to prescribed therapies or general pediatric care. However, pulmonary consultations and other chronic conditions were associated with repeated asthma hospitalizations.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Epidemiology
Background:
- Asthma is a significant, yet preventable, cause of childhood hospitalization.
- Multiple hospital admissions for asthma can occur in some pediatric populations.
Purpose of the Study:
- To investigate factors associated with repeated asthma hospitalizations in children.
- Examined medical history, pre-hospitalization, and post-discharge ambulatory care.
Main Methods:
- Nested case-control study involving 119 children (0-14 years) hospitalized for asthma.
- Compared children rehospitalized within one year to those not rehospitalized.
- Utilized medical charts, electronic records, and administrative data.
Main Results:
- Children with repeated asthma hospitalizations were more likely to have had a pulmonary consultation during their index admission or post-discharge.
- A higher prevalence of other chronic conditions was observed in readmitted children.
- No significant association found between readmissions and adherence to prescribed therapies or general pediatric care.
Conclusions:
- Readmission for pediatric asthma in low-income urban settings is not predicted by standard prescribed therapies or general pediatric care.
- Pulmonary consultations and co-existing chronic conditions are key factors associated with recurrent asthma hospitalizations.
Background:
Although some children with asthma experience multiple admissions, asthma is considered a preventable cause of hospitalization.
Objective:
To assess whether components of medical histories, ambulatory care prior to hospitalization, or ambulatory care after discharge are associated with repeated hospitalizations for children admitted with asthma.
Design:
Nested case-control study of a cohort of children hospitalized for asthma, comparing those who were rehospitalized within 1 year with those not rehospitalized.
Setting:
Urban pediatric primary care clinic.
Participants And Methods:
Subjects were 119 children, aged 0 to 14 years, who had an inpatient admission with a diagnosis of asthma between July 1, 1993, and June 30, 1995 (index hospitalization). Data sources included medical charts, computerized patient records, and administrative data. Use of health care services was compared among children who were rehospitalized within 1 year of the index admission and those who were not.
Main Outcome Measure:
Repeated hospitalizations.
Results:
The proportions of children who received general pediatric, allergy, or pulmonary care in the year prior to the index hospitalization were 86%, 7%, and 8%, respectively. By report, half of all children did not receive prescribed therapies, more than half were exposed to cigarette smoke at home, and one fourth were not up-to-date with immunizations at the time of admission. Thirty-five of the 119 children hospitalized with asthma were subsequently readmitted with asthma within 1 year of the index hospitalization. Children readmitted did not differ from those with a single admission in terms of the above characteristics. However, significantly more children subsequently readmitted had a pulmonary consultation during the index admission (23% vs 4%; P = .001) or in the year following discharge (37% vs 12%; P = .002). In addition, children readmitted were more likely to have other chronic conditions (69% vs 49%; P= .048).
Conclusion:
Among low-income urban children, readmission for asthma is not associated with receipt of prescribed therapies or pediatric care.