Association between outpatient follow-up and pediatric emergency department asthma visits.
BACKGROUND
The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma.


OBJECTIVE
To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit.


METHODS
We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from January 1998 to October 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider.


RESULTS
A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year.


CONCLUSIONS
Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.
Cabana
Michael D
MD
Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health Care System, Ann Arbor, Michigan 48109-0456, USA. mcabana@med.umich.edu
Bruckman
David
D
Bratton
Susan L
SL
Kemper
Alex R
AR
Clark
Noreen M
NM
D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001249:Asthma / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011320:Primary Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies