Bloomberg GR, Trinkaus KM, Fisher EB, Music JR, Strunk RC. Am J Respir Crit Care Med. 2003;167:1068–1076
Purpose of the Study.
To determine the magnitude of readmissions for children with asthma and to examine measurable risk factors for readmissions for asthma treatment.
All hospitalized children with a primary discharge diagnosis of asthma (International Classification of Diseases, 9th revision, code 493) at 2 large hospitals in St. Louis, Missouri, between January 1, 1990, and December 31, 1999, were included.
This was a retrospective analysis of children with asthma hospitalizations between January 1, 1990, and December 31, 1999. Data for admissions of patients with asthma were extracted from the billing databases of 2 hospitals for the 10-year period. Patient attributes of age, gender, race/ethnicity, residence, payer status, length of stay, and month of admission were compared between patients admitted once during that period and patients admitted multiple times. Extensive measures were undertaken to ensure that each patient’s hospital admissions for asthma were counted as accurately as possible. The main outcome measures were the total number of admissions and the time to readmission during the study interval.
During the study period, there were 8761 children with 14 905 hospitalizations because of asthma. Of these, 6142 were admitted only once and 2619 (30%) were admitted more than once. There were a total of 6144 readmissions (41.2% of total asthma admissions); 3525 of these were third admissions or more (23.6% of all asthma admissions). The largest numbers of admissions, both single and multiple, occurred among patients between 1 and 4 years of age. The ratio of African American patients to all other patients was 2.16 for single admissions and 4.38 for multiple admissions (χ2 test, P < .0001). The ratio of Medicaid or self-pay insurance to commercial insurance was 1.94 for the multiple-admission group and 1.29 for the single-admission group (χ2 test, P < .001). Prior admission was a more specific indicator of readmission, with greater positive predictive value, than ethnicity, insurance status, or their combination.
Readmissions for asthma treatment represented a substantial proportion of admissions, and there was a disproportionate association with African American race/ethnicity and low income, as indicated by insurance status. In addition, there was increasing risk for readmission with each subsequent asthma admission.
This is a very interesting study with practical clinical applications. As noted, any readmission for asthma treatment should be used as an impetus for intervention. Inpatient hospital services represent the largest direct medical expenditures for asthma treatment; therefore, identification of asthmatics at high risk for readmission is critical. Interventions to improve overall asthma management, including environmental controls, adherence to a written asthma action plan with appropriate medications, and specific attention to psychosocial issues, should help decrease readmissions. Continued research in this area, with particular emphasis on successful interventions to prevent readmissions for asthma treatment, will be very welcome.