Outcomes of follow-up care after an emergency department visit among pediatric asthmatics in the military health system.
OBJECTIVE
Asthma exacerbations frequently trigger emergency department (ED) visits. Guidelines recommend timely follow-up after an ED visit for asthma, however, other studies have questioned the quality of follow-up care and their effect on subsequent ED utilization. We evaluated follow-up care on asthma outcomes in pediatric asthmatics enrolled in the Military Health System (MHS) after an ED visit for asthma.


METHODS
This retrospective study utilized MHS data to evaluate 2-17-year-old persistent asthmatics with an ED visit for asthma between 2010-2012. Demographics, medication dispensing, and subsequent asthma related ED and hospital utilization were compared between those with or without a 28-day follow-up appointment.


RESULTS
10,460 of 88,837 persistent asthmatics met inclusion criteria for an asthma ED visit. 4,964 (47.5%) had ≥ 1 follow-up visit. In the 29-365 days after their ED visit, 21.1% of the follow-up cohort required an ED re-visit compared to 24.0% of the patients without follow-up. Follow-up care was associated with a reduction in ED re-visits (adjusted hazard ratio 0.86; 95% confidence interval 0.79, 0.93). Controller medications were dispensed to 76.0% of the follow-up cohort within 90 days of their ED visit compared to 49.7% in the group without follow-up.


CONCLUSIONS
Despite universal access to healthcare, less than half of pediatric MHS asthma patients had follow-up within 28 days of an ED visit. Those with follow-up were more likely to fill a controller medication within 90 days post-ED visit, and less likely to have an asthma ED re-visit in the subsequent year.
a Nationwide Children's Hospital , Columbus , OH , USA.
Michael
M
Smiley
b Health Research Tx LLC , Trevose , PA , USA.
Nicholas
N
Sicignano
b Health Research Tx LLC , Trevose , PA , USA.
Toni
T
Rush
c Naval Medical Research Unit Dayton, Wright Patterson AFB , OH , USA.
Rees
R
Lee
a Nationwide Children's Hospital , Columbus , OH , USA.
Elizabeth
E
Allen
D000293:Adolescent; D000359:Aftercare / Q000706:statistics & numerical data*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel
D018927:Anti-Asthmatic Agents
Asthma; emergency department; follow-up visits; pediatric