Readmission and Ambulatory Health Care Use After Asthma Hospitalization Among Urban Minority Children.

Abstract

The role of ambulatory follow-up after pediatric asthma hospitalization in preventing long-term readmissions is not well studied among hospitalized minority children. We sought to examine the association of ambulatory visit attendance with long-term readmission as well as identify predictors of attendance at these visits among urban, minority children with asthma. This 2-year retrospective cohort study analyzed data for urban, minority children 2 to 18 years old who were hospitalized for asthma at a tertiary-care center. Using bivariate and multivariable analyses, we examined the independent associations of attending a postdischarge visit (within 14 days), a routine visit (within 3 months of discharge or postdischarge visit), and both visits with likelihood of asthma readmission within 365 days. We also identified predictors of attending each of these visits. The study included 613 children with a median age of 5 years. Of the children, 57.4% were boys, 51.2% were Hispanic, and 36.9% were non-Hispanic African American. One-quarter of the children were readmitted within 365 days of the index hospitalization. Children who attended the postdischarge visit had lower odds of long-term readmission (odds ratio = 0.65; 95% confidence interval = 0.43-0.97). However, attending a routine or both a postdischarge and a routine visit was not significantly associated with long-term readmission. Children with previous sick visits, complicating comorbidities, or more severe exacerbation were more likely to attend visits. Attending a postdischarge visit within 14 days of hospitalization is associated with a lower likelihood of long-term readmission. Those with a previous sick visit, more severe disease, or exacerbation are more likely to attend ambulatory visits after hospital discharge. This knowledge is important in fostering quality care transitions for children with asthma.