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Association between outpatient follow-up and pediatric emergency department asthma visits

Michael D Cabana1, David Bruckman, Susan L Bratton

  • 1Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health Care System, Ann Arbor, Michigan 48109-0456, USA. mcabana@med.umich.edu

The Journal of Asthma : Official Journal of the Association for the Care of Asthma
|November 25, 2003
PubMed

Insights

Most children do not receive recommended asthma follow-up after emergency visits. Surprisingly, outpatient visits within 30 days increase the risk of repeat emergency department visits for asthma.

Area of Science:

  • Pediatric Pulmonology
  • Health Services Research
  • Epidemiology

Background:

  • National Heart, Lung, and Blood Institute guidelines advocate for outpatient follow-up post-emergency department (ED) asthma discharge.
  • Adherence to these guidelines is crucial for managing pediatric asthma exacerbations.

Purpose of the Study:

  • To evaluate the frequency of outpatient asthma visits following ED discharge.
  • To determine the association between these follow-up visits and the rate of repeat ED asthma visits.

Main Methods:

  • Retrospective cohort study utilizing claims data from a managed care organization (1998-2000).
  • Multivariate survival analysis (Cox proportional hazards model) assessed the impact of follow-up visits on repeat ED visits.
  • Controlled for illness severity, patient demographics, and provider specialty.

Main Results:

  • 17% of 561 children experienced a repeat ED asthma visit within one year.
  • 66% of children lacked outpatient asthma follow-up within 30 days of an ED visit.
  • Outpatient visits within 30 days correlated with an increased likelihood (RR=1.80) of repeat ED asthma visits.

Conclusions:

  • A significant majority of children do not receive recommended outpatient follow-up after ED asthma visits.
  • Outpatient follow-up within 30 days is paradoxically associated with a higher risk of repeat ED visits.
  • These follow-up visits present a critical opportunity for primary care providers to identify high-risk patients and implement preventive strategies for asthma management.
Abstract

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