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Follow-up Care After an Emergency Department Visit for Asthma in a Pediatric Military Population: Clinical Interventions and Outcomes FREE TO VIEW

Michael Smiley, MD; Nick Sicignano, MPH; Elizabeth Allen, MD; Rees Lee, MD; Deena Chisolm, PhD
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Nationwide Children's Hospital, Columbus, OH

Chest. 2015;148(4_MeetingAbstracts):674A. doi:10.1378/chest.2215462
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SESSION TITLE: Asthma Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 25, 2015 at 07:30 AM - 08:30 AM

PURPOSE: Our objective was to describe the follow-up care within 28 days of an emergency department (ED) visit for asthma in pediatric patients in the DOD Military Health System (MHS) and to evaluate the impact of follow-up visits on ED re-visits and hospitalizations for asthma in the subsequent year.

METHODS: This retrospective observational study used MHS data between Jan 1, 2010 and Dec 31, 2013. Eligible patients were 2-17 year old beneficiaries with ≥ 1 asthma diagnosis and ≥ 4 asthma medication dispensing events. This previously validated algorithm was used based on its ability to identify clinically persistent asthma. From this cohort, patients with an ED visit for asthma within 2010-2012 were followed for both follow-up care within 28 days of discharge and 1-year outcomes. Patients hospitalized from the ED were excluded. Outcomes were ED re-visits and hospitalizations for asthma within 29-365 days after index ED visit. Cox proportional hazard models were used to assess associations of follow-up care and patient characteristics with 1-year outcomes.

RESULTS: Of the 88,837 persistent asthmatics identified, 12,514 (14.1%) had an ED visit for asthma without a hospitalization. 48.8% (n=6,109) had follow-up within 28 days, with median (IQR) time to initial follow-up of 4(8) days. Of the follow-up cohort, 1,344 (22.0%) had an ED re-visit and 174 (2.8%) had a hospital admission, with median (IQR) time from index ED visit to outcome of 158 (167.5) days and 151.5 (189) days, respectively. Of the cohort with no follow-up, 1,556 (24.3%) had an ED re-visit and 149 (2.3%) had a hospitalization, with median (IQR) time from index ED visit to outcome of 155.5 (166.5) days and 143 (133) days, respectively. When adjusted for age and gender, follow-up care was found to be associated with decreased ED re-visits (hazard ratio 0.87; 95% CI 0.81, 0.94) but not hospitalizations (hazard ratio 1.16; 95% CI 0.93, 1.44).

CONCLUSIONS: Despite universal access to healthcare, only half of patients had follow-up within 28 days after an ED visit for asthma. In contrast to a previous study in a universal-access healthcare system (J Pediatr 2012;161:208-213), our preliminary results show that patients with follow-up had a mild benefit in terms of ED re-visits for asthma in the subsequent year. Fully adjusted Cox proportional hazard models are currently being implemented to better evaluate potential associations.

CLINICAL IMPLICATIONS: More research is needed to delineate whether specific interventions at follow-up are needed to improve outcomes. The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government. Research data was derived from an approved Naval Medical Center, Portsmouth, VA IRB protocol. Dr. Mike Smiley and Dr. Rees Lee are members of the US Military. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.

DISCLOSURE: The following authors have nothing to disclose: Michael Smiley, Nick Sicignano, Elizabeth Allen, Rees Lee, Deena Chisolm

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