title: Follow-up care after an emergency department visit for asthma and subsequent healthcare utilization in a universal-access healthcare system.
abstract: OBJECTIVE
  To describe the follow-up care within 28 days of an emergency department (ED) visit for asthma and to determine the association of follow-up visits within 28 days with ED re-visits and hospital admissions in the subsequent year.
  
  
  METHODS
  Population-based retrospective cohort study of children with asthma aged 2-17 years treated in an ED in Ontario, Canada between April 14, 2006 and February 28, 2009. Multiple linked health administrative datasets and Cox proportional hazard multivariable survival models were used to test the association of characteristics of 28-day follow-up visits with 1-year outcomes.
  
  
  RESULTS
  The final cohort consisted of 29391 children, of whom 32.8% had follow-up, 6496 (22.1%) had an ED re-visit, and 801 (2.7%) had a hospital admission. Having a follow-up visit was not associated with ED re-visit or hospitalizations (hazard ratio 0.98; 95% CI 0.93, 1.03 and hazard ratio 1.06; 95% CI 0.92, 1.23, respectively). Younger children and those with indices of more severe acute or chronic asthma were more likely to have ED re-visits and hospitalizations. Other follow-up care characteristics (number of visits, type of physician providing care) were not associated with outcomes.
  
  
  CONCLUSIONS
  Despite a universal healthcare setting, most children did not access follow-up care after an ED visit for asthma, and those that did had no associated benefit in terms of reduced ED re-visits and hospitalizations in the subsequent year.
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Li
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D010359:Patient Readmission; D012959:Socioeconomic Factors