title: A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department?
abstract: BACKGROUND
  Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population.
  
  
  OBJECTIVE
  We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits.
  
  
  METHODS
  A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit.
  
  
  RESULTS
  Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits).
  
  
  CONCLUSIONS
  This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these major gaps in asthma care.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: khasegawa1@partners.org.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Eva
authors.initials: E
authors.lastname: Tovar Hirashima
authors.affiliation: Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Gaeta
authors.affiliation: Department of Emergency Medicine, University of California San Francisco Medical Center, San Francisco, Calif.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fee
authors.affiliation: Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Turner
authors.affiliation: Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Susan
authors.initials: S
authors.lastname: Massaro
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Acute asthma; Emergency department; Epidemiology exacerbation; Health care utilization; Racial disparity; Socioeconomic status