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Cluster Analysis of Acute Care Use Yields Insights for Tailored Pediatric Asthma Interventions
Mahshid Abir1, Aaron Truchil2, Dawn Wiest2
1Department of Emergency Medicine, Acute Care Research Unit, University of Michigan, Ann Arbor, MI; RAND Corporation, Santa Monica, CA.
Insights
This study identified five distinct patterns of pediatric asthma acute care use. Understanding these patterns can help reduce potentially avoidable hospitalizations for children with asthma.
Area of Science:
- Pediatric Healthcare
- Respiratory Medicine
- Health Services Research
Background:
- Pediatric asthma necessitates effective acute care strategies.
- Reducing avoidable hospitalizations is a key healthcare objective.
Purpose of the Study:
- To identify and characterize distinct patterns of acute care utilization among pediatric asthma patients.
- To inform the development of targeted interventions for reducing hospitalizations.
Main Methods:
- Analysis of hospital claims data from 2010-2014 for children (0-17 years) with asthma.
- Cluster analysis based on asthma-related emergency department (ED) visits and hospitalizations.
- Comparison of demographic, sociobehavioral, and service use characteristics across identified clusters.
Main Results:
- Five distinct clusters of pediatric asthma patients based on acute care use were identified.
- Cluster 1 (62%) had minimal acute care use; Cluster 5 (1%) exhibited extreme use.
- Other clusters showed varying combinations of ED visits, hospitalizations, and facility use, with some linked to mental health diagnoses and multi-facility care.
Conclusions:
- Distinct clusters of pediatric asthma patients demonstrate varied acute care utilization patterns.
- Sociobehavioral factors differ across clusters, suggesting a multi-dimensional basis for these patterns.
- These findings support the development of tailored interventions to manage pediatric asthma and reduce acute care needs.
Study Objective:
We undertake this study to understand patterns of pediatric asthma-related acute care use to inform interventions aimed at reducing potentially avoidable hospitalizations.
Methods:
Hospital claims data from 3 Camden city facilities for 2010 to 2014 were used to perform cluster analysis classifying patients aged 0 to 17 years according to their asthma-related hospital use. Clusters were based on 2 variables: asthma-related ED visits and hospitalizations. Demographics and a number of sociobehavioral and use characteristics were compared across clusters.
Results:
Children who met the criteria (3,170) were included in the analysis. An examination of a scree plot showing the decline in within-cluster heterogeneity as the number of clusters increased confirmed that clusters of pediatric asthma patients according to hospital use exist in the data. Five clusters of patients with distinct asthma-related acute care use patterns were observed. Cluster 1 (62% of patients) showed the lowest rates of acute care use. These patients were least likely to have a mental health-related diagnosis, were less likely to have visited multiple facilities, and had no hospitalizations for asthma. Cluster 2 (19% of patients) had a low number of asthma ED visits and onetime hospitalization. Cluster 3 (11% of patients) had a high number of ED visits and low hospitalization rates, and the highest rates of multiple facility use. Cluster 4 (7% of patients) had moderate ED use for both asthma and other illnesses, and high rates of asthma hospitalizations; nearly one quarter received care at all facilities, and 1 in 10 had a mental health diagnosis. Cluster 5 (1% of patients) had extreme rates of acute care use.
Conclusion:
Differences observed between groups across multiple sociobehavioral factors suggest these clusters may represent children who differ along multiple dimensions, in addition to patterns of service use, with implications for tailored interventions.
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