Colleen Marie McGovern1, Margaret Redmond2, Kimberly Arcoleo3, David R Stukus2. 1. a College of Nursing, The Ohio State University , Columbus , OH , USA. 2. b Section of Allergy and Immunology , Nationwide Children's Hospital , Columbus , OH , USA. 3. c School of Nursing, University of Rochester School of Nursing , Rochester , NY , USA.
Abstract
OBJECTIVE: Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits. METHODS: Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2-18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. RESULTS: None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ2 = 64.28, p <.0001). Males were significantly more likely to have an ED visit following a missed PC appointment than females (χ2 = 34.37, p <.0001). There was a statistically significant interaction of sex × age. Younger children (<12 years) made more visits than older children. CONCLUSIONS: The importance of adherence to PC appointments for children with asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.
OBJECTIVE: Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits. METHODS: Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2-18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. RESULTS: None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ2 = 64.28, p <.0001). Males were significantly more likely to have an ED visit following a missed PC appointment than females (χ2 = 34.37, p <.0001). There was a statistically significant interaction of sex × age. Younger children (<12 years) made more visits than older children. CONCLUSIONS: The importance of adherence to PC appointments for children with asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.
Entities:
Keywords:
Asthma exacerbation; emergency department utilization; missed appointments; pediatric asthma; primary care
Authors: Hector R Perez; Michele Buonora; Chinazo O Cunningham; Moonseong Heo; Joanna L Starrels Journal: J Gen Intern Med Date: 2019-08-19 Impact factor: 5.128
Authors: Gregory A Peters; Alexander J Ordoobadi; Rebecca E Cash; Matthew L Wong; Paul Avillach; Carlos A Camargo Journal: JAMA Netw Open Date: 2020-11-02