OBJECTIVE: To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. DESIGN: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. RESULTS: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. CONCLUSIONS: High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.
OBJECTIVE: To characterize adult asthmapatients according to frequency of emergency department (ED) visits in the past year. DESIGN: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. RESULTS: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. CONCLUSIONS: High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.
Authors: Wendy C Moore; Eugene R Bleecker; Douglas Curran-Everett; Serpil C Erzurum; Bill T Ameredes; Leonard Bacharier; William J Calhoun; Mario Castro; Kian Fan Chung; Melissa P Clark; Raed A Dweik; Anne M Fitzpatrick; Benjamin Gaston; Mark Hew; Iftikhar Hussain; Nizar N Jarjour; Elliot Israel; Bruce D Levy; James R Murphy; Stephen P Peters; W Gerald Teague; Deborah A Meyers; William W Busse; Sally E Wenzel Journal: J Allergy Clin Immunol Date: 2007-02 Impact factor: 10.793
Authors: Michael E Wechsler; Stanley J Szefler; Victor E Ortega; Jacqueline A Pongracic; Vernon Chinchilli; John J Lima; Jerry A Krishnan; Susan J Kunselman; David Mauger; Eugene R Bleecker; Leonard B Bacharier; Avraham Beigelman; Mindy Benson; Kathryn V Blake; Michael D Cabana; Juan-Carlos Cardet; Mario Castro; James F Chmiel; Ronina Covar; Loren Denlinger; Emily DiMango; Anne M Fitzpatrick; Deborah Gentile; Nicole Grossman; Fernando Holguin; Daniel J Jackson; Harsha Kumar; Monica Kraft; Craig F LaForce; Jason Lang; Stephen C Lazarus; Robert F Lemanske; Dayna Long; Njira Lugogo; Fernando Martinez; Deborah A Meyers; Wendy C Moore; James Moy; Edward Naureckas; J Tod Olin; Stephen P Peters; Wanda Phipatanakul; Loretta Que; Hengameh Raissy; Rachel G Robison; Kristie Ross; William Sheehan; Lewis J Smith; Julian Solway; Christine A Sorkness; Lisa Sullivan-Vedder; Sally Wenzel; Steven White; Elliot Israel Journal: N Engl J Med Date: 2019-09-26 Impact factor: 91.245
Authors: Bernhard A Fassl; Flory L Nkoy; Bryan L Stone; Rajendu Srivastava; Tamara D Simon; Derek A Uchida; Karmella Koopmeiners; Tom Greene; Lawrence J Cook; Christopher G Maloney Journal: Pediatrics Date: 2012-08-20 Impact factor: 7.124