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Predicting readmission to hospital with asthma
D Raymond1, R L Henry, N Higginbotham
1University of New South Wales, Kensington, Australia. dennisr@hawknet.com.au
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Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Health Psychology
Background:
- Asthma is a common chronic respiratory disease in children.
- Hospital readmissions for pediatric asthma are a significant healthcare burden.
- Predicting readmission risk is crucial for effective asthma management.
Purpose of the Study:
- To identify predictors of hospital readmission in children aged 1-7 years with asthma.
- To investigate the role of parental perceptions of inhaled therapy in readmission risk.
- To explore the influence of asthma severity and past patterns on readmission outcomes.
Main Methods:
- A questionnaire assessed parental factors including treatment perceptions and self-efficacy.
- Clinical assessment evaluated asthma attack severity and past asthma patterns.
- 121 children admitted with asthma were followed for one year to determine readmission rates.
Main Results:
- Negative perceived consequences of inhaled therapy were associated with increased readmission risk (P=0.04).
- This association was particularly strong in children with infrequent episodic asthma.
- A decrease in negative perceived consequences significantly reduced the odds of readmission (OR=0.31).
Conclusions:
- Parental negative perceptions of asthma treatment are linked to higher readmission rates.
- Addressing these negative perceptions may reduce pediatric asthma readmissions.
- Treatment adherence and outcomes are influenced by parental beliefs and asthma severity.
Objectives:
To determine whether readmission to hospital for children aged 1-7 years with asthma can be predicted; and to discover whether factors related to the severity of the attack and past pattern of asthma, assessment of the parents' intention to treat the child with inhaled therapy, perceived consequences of treatment, habits of treatment and self-efficacy show a difference between those children subsequently readmitted and those who were not.
Methods:
A specifically developed questionnaire was administered to parents of 121 children admitted with asthma. Clinical assessment was made of severity of the acute attack and past pattern of the asthma. One year after admission subjects were reviewed to determine those who had been readmitted.
Results:
On univariate analysis, the negative perceived consequences of treatment with inhaled therapy were associated with an increased risk of readmission over a one-year period (P = 0.04). After adjusting for confounders (place of birth of mother, two- or one-parent family) and the effect-modifier of past pattern of the asthma (infrequent episodic, frequent episodic, persistent), the greater the negative perceived consequences of treatment, the more likely there would be readmission in children with infrequent episodic asthma. After adjusting for potential confounders, using logistic regression a decrease of one standard deviation in the negative perceived consequences score resulted in a one-third decrease in the odds of readmission (odds ratio (OR) = 0.31, 95% CI 0.12-0.83).
Conclusions:
Parents whose children are readmitted see greater negative perceived consequences of treatment. If asthma is infrequent episodic, the negative perceived consequences may be an inhibitor of treatment, whereas for more severe past patterns of asthma the severity is the controller of treatment. If parental negative consequences could be decreased, admissions for asthma may decrease.