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Kohei Hasegawa, MD, MPH; Yusuke Tsugawa, MD, PhD; Carlos A. Camargo, Jr., MD, DrPH
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

bDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA

CORRESPONDENCE TO: Kohei Hasegawa, MD, MPH, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Ste 920 Boston, MA 02114


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(5):1165-1166. doi:10.1016/j.chest.2016.07.042
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We agree with Veeranki and colleagues that our analysis of several Healthcare Cost and Utilization Project state inpatient databases, from 2005 through 2011, could have yielded results that did not generalize well to the entire US population. Conversely, the three analyzed states (California, Florida, and Nebraska) are racially/ethnically diverse and geographically dispersed, and they together represent approximately 20% of the US population. We are pleased to learn that our main finding—that is, that older adults hospitalized for asthma exacerbations are at a higher risk of 30-day readmission compared with younger adults—has been replicated in their analysis of the 2013 Healthcare Cost and Utilization Project National Readmission Database (NRD).

Interestingly, the overall 30-day readmission date was similar (14.5% in our analysis vs 14.2% in the analysis by Veeranki et al) across the analyses using different study periods. Most of the data that we studied were from before the enactment of the Patient Protection and Affordable Care Act (March 2010), whereas the NRD data are from after the implementation of the Hospital Readmissions Reduction Program (October 2012). This program penalizes hospitals that have higher-than-expected 30-day readmission rates for the three selected conditions (acute myocardial infarction, heart failure, and pneumonia). The absence of substantial change in the 30-day readmission rate across the two study periods—notwithstanding the differences in sampling methods (population-based sampling in the state inpatient databases vs complex sampling in the NRD) and number of study states (three vs 21)—suggests that adults hospitalized for an asthma exacerbation might have had no substantial “spillover benefit” from actions that hospitals took in response to the Hospital Readmissions Reduction Program. Although the reasons for the lack of improvement in readmission rate require further elucidation, we recently found, in a 25-center observational study of patients hospitalized for asthma exacerbation during 2012 and 2013, that the previously identified quality deficits persist in both inpatient (eg, smoking cessation intervention) and postdischarge (eg, development of a written action plan, referral to specialists) asthma care.,

The results of the state inpatient databases and NRD analyses, coupled with our recent multicenter study,, should encourage clinicians and researchers to bridge these quality chasms in acute asthma care; doing so is likely to achieve better asthma control and reduce readmissions. The large burden of asthma-related readmissions (14%-15%) underscores the importance of reducing these readmissions, a multifaceted effort that should remain a national priority.

References

Hasegawa K. .Gibo K. .Tsugawa Y. .Shimada Y.J. .Camargo C.A. Jr.. Age-related differences in the rate, timing, and diagnosis of 30-day readmissions in hospitalized adults with asthma exacerbation. Chest. 2016;149:1021-1029 [PubMed]journal. [CrossRef] [PubMed]
 
US Census Bereau. Population estimates.http://www.census.gov/popest/. Accessed July 23, 2016.
 
Zuckerman R.B. .Sheingold S.H. .Orav E.J. .Ruhter J. .Epstein A.M. . Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016;374:1543-1551 [PubMed]journal. [CrossRef] [PubMed]
 
Bittner J.C. .Hasegawa K. .Probst B.D. .Mould-Millman N.K. .Silverman R.A. .Camargo C.A. Jr.. Smoking status and smoking cessation intervention among US adults hospitalized for asthma exacerbation. Allergy Asthma Proc. 2016;37:318-323 [PubMed]journal. [CrossRef] [PubMed]
 
Hasegawa K. .Tsugawa Y. .Clark S. .et al Improving quality of acute asthma care in US hospitals: changes between 1999-2000 and 2012-2013. Chest. 2016;150:112-122 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Hasegawa K. .Gibo K. .Tsugawa Y. .Shimada Y.J. .Camargo C.A. Jr.. Age-related differences in the rate, timing, and diagnosis of 30-day readmissions in hospitalized adults with asthma exacerbation. Chest. 2016;149:1021-1029 [PubMed]journal. [CrossRef] [PubMed]
 
US Census Bereau. Population estimates.http://www.census.gov/popest/. Accessed July 23, 2016.
 
Zuckerman R.B. .Sheingold S.H. .Orav E.J. .Ruhter J. .Epstein A.M. . Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016;374:1543-1551 [PubMed]journal. [CrossRef] [PubMed]
 
Bittner J.C. .Hasegawa K. .Probst B.D. .Mould-Millman N.K. .Silverman R.A. .Camargo C.A. Jr.. Smoking status and smoking cessation intervention among US adults hospitalized for asthma exacerbation. Allergy Asthma Proc. 2016;37:318-323 [PubMed]journal. [CrossRef] [PubMed]
 
Hasegawa K. .Tsugawa Y. .Clark S. .et al Improving quality of acute asthma care in US hospitals: changes between 1999-2000 and 2012-2013. Chest. 2016;150:112-122 [PubMed]journal. [CrossRef] [PubMed]
 
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