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Clinical Investigations: ASTHMA |

Asthma Exacerbations in North American Adults*: Who Are the “Frequent Fliers” in the Emergency Department?

Sharon K. Griswold, MD; Carla R. Nordstrom, MD, MPH; Sunday Clark, MPH; Theodore J. Gaeta, DO, MPH; Michelle L. Price; Carlos A. Camargo, Jr, MD, DrPH
Author and Funding Information

*From the Department of Emergency Medicine Dr. Griswold and Ms. Price), Thomas Jefferson University Hospital, Philadelphia, PA; Department of Critical Care Medicine (Dr. Nordstrom), Mercy Hospital of Philadelphia, Philadelphia, PA; Department of Emergency Medicine (Ms. Clark and Dr. Camargo), Massachusetts General Hospital, Boston, MA; and Department of Emergency Medicine (Mr. Gaeta), Methodist Hospital, Brooklyn, NY.

Correspondence to: Sharon Griswold, MD, 1020 Sansom St, Room 1651, Thompson Building, Philadelphia, PA 19107; e-mail: sharon.griswold@jefferson.edu



Chest. 2005;127(5):1579-1586. doi:10.1378/chest.127.5.1579
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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.

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