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Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A
Gregory A Peters1,2,3, Rebecca E Cash1,2, Scott A Goldberg1,3
1Harvard Medical School, Boston, Massachusetts.
Insights
Unnecessary pediatric asthma transfers are linked to younger age, male gender, and Hispanic ethnicity. Frequent hospitalizations for asthma reduce the likelihood of such transfers.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Health Services Research
Background:
- Asthma is a leading cause of pediatric interfacility transfers.
- Up to 40% of pediatric asthma transfers may be unnecessary, increasing costs and delaying care.
Purpose of the Study:
- To identify patient-related factors associated with potentially unnecessary interfacility transfers for pediatric asthma patients.
Main Methods:
- Analysis of California discharge and ED data for pediatric asthma patients (age 2-17) transferred between facilities.
- Defined unnecessary transfers as those with <24-hour length of stay and no advanced services post-transfer.
- Used generalized estimating equations to identify associated patient characteristics.
Main Results:
- 11% of 4,233 pediatric asthma transfers were deemed potentially unnecessary.
- Younger age (2-5 years), male gender, and Hispanic ethnicity were associated with increased odds of unnecessary transfers.
- Multiple prior asthma hospitalizations per year decreased the odds of unnecessary transfers.
Conclusions:
- Patient demographics and prior healthcare utilization influence the likelihood of unnecessary pediatric asthma transfers.
- Identifying these factors can inform strategies to reduce unnecessary transfers and improve pediatric asthma care.
Background/Objective:
Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma.
Methods:
We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers.
Results:
A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4).
Conclusion:
Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.
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