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A missed primary care appointment correlates with a subsequent emergency department visit among children with asthma
Colleen Marie McGovern1, Margaret Redmond2, Kimberly Arcoleo3
1a College of Nursing, The Ohio State University , Columbus , OH , USA.
Insights
Adhering to primary care appointments for children with asthma significantly reduces emergency department visits. Interventions addressing missed appointments can lower asthma-related hospitalizations and healthcare costs.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Public Health
Background:
- Emergency department (ED) visits for asthma are increasing, particularly after the Affordable Care Act.
- Poorly controlled asthma leads to exacerbations and preventable ED visits, increasing healthcare costs.
- Reducing preventable ED visits is a priority for healthcare systems, yet data on missed primary care (PC) appointments for pediatric asthma are limited.
Purpose of the Study:
- To examine the association between missed primary care appointments and subsequent emergency department visits in children with asthma.
- To identify factors influencing emergency department utilization in pediatric asthma patients.
Main Methods:
- A retrospective review of 3895 children aged 2-18 with asthma was conducted.
- Data from January 2010 to June 2012 for PC appointments were cross-referenced with asthma-related ED visits until December 2012.
- Logistic regression analysis was used to determine the association between missed PC appointments and ED visits.
Main Results:
- Children who missed PC appointments were significantly more likely to have an ED visit compared to those who attended (2.7% vs. 0%).
- Males were more likely than females to have an ED visit after missing a PC appointment.
- Younger children (<12 years) had more ED visits than older children.
Conclusions:
- Adherence to primary care appointments is crucial for preventing emergency department visits in children with asthma.
- Targeting interventions to reduce missed primary care appointments can decrease asthma-related morbidity and healthcare expenditures.
- Improving primary care access and adherence can mitigate the burden of preventable emergency department visits.
Objective:
Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits.
Methods:
Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2-18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted.
Results:
None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ2 = 64.28, p <.0001). Males were significantly more likely to have an ED visit following a missed PC appointment than females (χ2 = 34.37, p <.0001). There was a statistically significant interaction of sex × age. Younger children (<12 years) made more visits than older children.
Conclusions:
The importance of adherence to PC appointments for children with asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.
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