The impact of care management for high-risk pediatric asthmatics on healthcare utilization
Yingbo Lou1,2, Adam Atherly3, Tracy Johnson1
1Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA.
Insights
Quality improvement interventions significantly reduced urgent care visits and hospitalizations for children with persistent asthma. These interventions improved healthcare access and outcomes for pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Public Health Interventions
Background:
- Persistent asthma affects a significant number of children, leading to frequent healthcare utilization.
- Quality improvement initiatives are crucial for managing chronic pediatric conditions like asthma.
- Access to specialist care and proactive patient management can mitigate severe asthma exacerbations.
Purpose of the Study:
- To evaluate the impact of quality improvement interventions on pediatric persistent asthma patients.
- To assess changes in urgent care visits, emergency department visits, and hospitalizations.
- To determine the effectiveness of interventions including recalls and specialist access.
Main Methods:
- Utilized electronic medical records to identify pediatric patients with persistent asthma criteria.
- Analyzed asthma utilization events (urgent care, ED visits, hospitalizations) between 2011 and 2015.
- Employed logistic regression to compare utilization rates before and after intervention enrollment.
Main Results:
- 1060 children with persistent asthma received interventions.
- Intervention group showed reduced likelihood of urgent care visits (OR [0.80, 0.96]) and hospitalizations (OR [0.37, 0.75]).
- Adjusted analysis confirmed significant reductions in hospitalizations and urgent care visits.
Conclusions:
- Quality improvement interventions are effective in reducing healthcare utilization for pediatric persistent asthma.
- Proactive management strategies, including specialist access, positively impact asthma outcomes.
- Interventions led to decreased hospitalizations and urgent care visits among pediatric asthma patients.
Introduction:
From 2011 to 2015, a series of quality improvement interventions were developed that targeted pediatric persistent asthmatics that included recalls for those overdue for care and access to specialist care. The objective of this study was to assess the impact on urgent care and emergency department visits and hospitalizations from enrollment into at least one intervention during the time period.
Methods:
Persistent asthmatics were identified through electronic medical records, with patients having an asthma designation containing "persistent," asthma control containing "poor", and asthma risk being "high risk." Asthma utilization events were identified for these patients between January 1, 2011, and June 30, 2015 using ICD-9 diagnosis codes. Evaluation focused on differences in utilization for patients before and after receiving interventions through the use of logistic regression for each utilization outcome.
Results:
The interventions were delivered to 1060 children out of a total of 2046 identified as having the persistent asthmatic criteria. The intervention group consisted of 389 (36.7%) moderate persistent asthmatics and 643 (60.7%) mild persistent asthmatics, with 976 (92.1%) identifying as a minority. Analysis of 60692 months of data showed patients who received the intervention were less likely to visit the urgent care (OR [0.80, 0.96]) or be hospitalized (OR [0.37, 0.75]) than those who did not receive any interventions. Adjustment for provider referral into the interventions resulted in slight changes for both hospitalizations (OR [0.38, 0.79]) and urgent care (OR [0.68, 0.94]).
Conclusion:
Children receiving interventions were less likely to be hospitalized or visit urgent care clinics.
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