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Published on: August 7, 2017
Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study
Katherine Yh Chen1,2,3, Wanyu Chu1, Renee Jones1
1Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.
Insights
Pediatric asthma readmissions are high in Australia, with young children most affected. General practitioner care discordant with guidelines increases readmission risk for children with asthma.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Epidemiology
Background:
- Asthma is a significant respiratory illness in children, leading to frequent hospitalizations.
- Understanding factors influencing pediatric asthma readmissions is crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To determine the rates of hospital readmission and emergency department (ED) re-presentation for pediatric asthma within 12 months.
- To assess the impact of hospital, general practitioner (GP), and home environmental factors on asthma-related healthcare utilization.
Main Methods:
- A cohort of 767 children (3-18 years) hospitalized for asthma in Victoria, Australia, was studied.
- Linked administrative datasets tracked primary outcomes (hospital readmission), secondary outcomes (ED re-presentation, oral corticosteroid use).
- Caregiver and GP surveys collected data on home environment and asthma management.
Main Results:
- A 12-month readmission rate of 34.3% was observed, with 69.2% of readmitted children aged 3-5 years.
- GP-reported guideline-discordant care was associated with increased odds of readmission (OR 1.57, p=0.05).
- No significant associations were found between hospital or home environmental factors and readmissions.
Conclusions:
- Pediatric asthma hospital readmissions in Australia are substantial, particularly in younger children.
- Linked datasets are valuable for assessing the healthcare burden of pediatric asthma.
- General practitioners play a critical role in managing pediatric asthma effectively.
Objectives:
To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use.
Methods:
We recruited 767 children aged 3-18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively.
Results:
Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3-5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00-2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions.
Conclusions:
Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.
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