Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits |
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Authors: | Michael D Cabana David Bruckman Susan L Bratton Alex R Kemper Noreen M Clark |
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Institution: |
a Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan Health Care System, Ann Arbor, Michigan, USA
b Division of Pediatric Critical Care Medicine, University of Michigan Health Care System, Ann Arbor, Michigan, USA
c Department of Health Behavior and Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA |
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Abstract: | Background.?The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. Objective.?To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. Design.?We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from 01 1998 to 10 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. Results:?A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. Conclusions.?Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits. |
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Keywords: | Asthma guidelines Quality of care Primary care Emergency department Follow-up |
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