Pediatric asthma hospitalizations among urban minority children and the continuity of primary care.
OBJECTIVE
To examine the effect of ambulatory health care processes on asthma hospitalizations.


METHODS
A retrospective cohort study using electronic health records was completed. Patients aged 2-18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives. Occurrence of one or more asthma hospitalizations was the primary outcome of interest. We used a log linear model (Poisson regression) to model the association between the factors of interest and number of asthma hospitalizations.


RESULTS
5,712 children with asthma were available for analysis. 96% of the children were African American. The overall hospitalization rate was 64 per 1,000 children per year. None of the commonly used asthma-specific indicators of high quality care were associated with fewer asthma hospitalizations. Children with documented asthma who experienced a lack of primary health care (no more than one outpatient visit at their primary care location in the 2 years preceding hospitalization) were at higher risk of hospitalization compared to those children with a greater number of visits (incidence rate ratio 1.39; 95% CI 1.09-1.78).


CONCLUSIONS
In children with asthma, more frequent primary care visits are associated with reduced asthma hospitalizations.
a Department of Biomedical and Health Informatics , Children's Hospital of Philadelphia , Philadelphia , PA , USA.|b Department of Pediatrics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Levon H
http://orcid.org/0000-0002-2189-108X
LH
Utidjian
a Department of Biomedical and Health Informatics , Children's Hospital of Philadelphia , Philadelphia , PA , USA.|b Department of Pediatrics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.|c Center for Pediatric Clinical Effectiveness , Children's Hospital of Philadelphia , Philadelphia , PA , USA.|d Pediatric Research Consortium , Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Alexander G
AG
Fiks
e Department of Biostatistics and Epidemiology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
A Russell
AR
Localio
f Healthcare Analytics Unit , Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Lihai
L
Song
a Department of Biomedical and Health Informatics , Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Mark J
MJ
Ramos
b Department of Pediatrics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.|c Center for Pediatric Clinical Effectiveness , Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Ron
R
Keren
b Department of Pediatrics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.|c Center for Pediatric Clinical Effectiveness , Children's Hospital of Philadelphia , Philadelphia , PA , USA.|d Pediatric Research Consortium , Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Louis M
LM
Bell
a Department of Biomedical and Health Informatics , Children's Hospital of Philadelphia , Philadelphia , PA , USA.|b Department of Pediatrics, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.|c Center for Pediatric Clinical Effectiveness , Children's Hospital of Philadelphia , Philadelphia , PA , USA.|d Pediatric Research Consortium , Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Robert W
RW
Grundmeier
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D010347:Patient Care Planning / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013147:Spirometry; D014505:Urban Population / Q000706:statistics & numerical data
D018927:Anti-Asthmatic Agents; D007252:Influenza Vaccines
Management/control; pediatrics; prevention