Asthma program evaluation: Impact of tertiary Asthma Care Network on ED visits and hospitalizations

Abstract

Rationale: Program evaluation is often hampered by lack of comparative control data. We aimed to determine the impact of an interdisciplinary tertiary Asthma Care (ACN) on acute health services utilization (HSU). Methods: Data from ACN patients seen between Jan 1, 2009 and Dec 31, 2018 were linked to Ontario’s administrative databases at the Institute for Clinical Evaluative Sciences (ICES). Control subjects matched for age, sex and year of asthma diagnosis were identified from the ICES asthma cohort. We assessed the odds of ED visits and hospitalizations for asthma between cases and controls, adjusting for acute HSU in the 12 months preceding the index visit. Results: Health records from 1,248 ACN patients (age 33.2 ± 25.0 [mean±SD] years, 57% female) were matched 1:3 to 3,629 Controls (age 32.7 ± 24.9, years, 57% female). ORs are shown in Table 1. ED visits and hospitalizations were reduced for 21% and 10.7% of ACN patients respectively, compared to 6.7% and 1.4% of Controls respectively (both P<0.001). Conclusions: Compared to control subjects identified from health administrative data, HSU is higher in patients seen in a tertiary ACN, and those with a history of previous ED visits and comorbidities. ACN patients experienced greater improvements in HSU in the 2 years following their index visit. Linking clinical and administrative data lends rigour to program evaluation and will inform quality improvement