Follow-up visit 14 days after an asthma-related ED visit decreases subsequent asthma-related ED revisits

About 25 million Americans have asthma. This equals to about 1 in 13 Americans, including 8 percent of adults and 7 percent of children. About 20 million U.S. adults age 18 and over have asthma. Asthma is more common in adult women than adult men.

A recent study assess the association between follow-up after an asthma-related emergency department (ED) visit and the likelihood of subsequent asthma-related ED utilization.

The study findings are published in The Official Journal of the Academic Pediatric Association, 2022

The study found that a positive association between outpatient 14-day follow-up and asthma-related ED revisits. It improved asthma control as providers follow the NHLBI guideline stepwise approach and highlights an opportunity for improvement, with only 22.6% of those with asthma-related ED visits having 14-day follow-up.

The study used data from California Medicaid (2014–2016), and Vermont (2014–2016) and Massachusetts (2013–2015) all-payer claims databases, we identified asthma-related ED visits for patients ages 3 to 21. Follow-up was defined as a visit within 14 days with a primary care provider or an asthma specialist. Outcome: asthma-related ED revisit after the initial ED visit. Models included logistic regression to assess the relationship between 14-day follow-up and the outcome at 60 and 365 days, and mixed-effects negative binomial regression to assess the relationship between 14-day follow-up and repeated outcome events (# ED revisits/100 child-years). All models accounted for zip-code level clustering.

The results of the study

• There were 90,267 ED visits, of which 22.6% had 14-day follow-up. Patients with follow-up were younger and more likely to have commercial insurance, complex chronic conditions, and evidence of prior asthma.

• 14-day follow-up was associated with decreased subsequent asthma-related ED revisits at 60 days (5.7% versus 6.4%, P < .001) and at 365 days (25.0% versus 28.3%, P < 0.001).

• Similarly, 14-day follow-up was associated with a decrease in the rate of repeated subsequent ED revisits (66.7 versus 77.3 revisits/100 child-years; P < 0.001).

Researchers concluded that "We found a protective association between outpatient 14-day follow-up and asthma-related ED revisits. This may reflect improved asthma control as providers follow the NHLBI guideline stepwise approach. Our findings highlight an opportunity for improvement, with only 22.6% of those with asthma-related ED visits having 14-day follow-up."

Reference: https://doi.org/10.1016/j.acap.2021.10.015