Asthma-related Readmission Research Articles

Mediating Role of Socio-Environmental Factors in the Relationship between Genetic Ancestry Differences and Pediatric Asthma Readmission

Genetic ancestry studies have predominately looked for direct biologic effects on disease. This study sought to determine whether asthma-related readmissions differed by African ancestry and the extent to which such an association would be mediated by socioenvironmental factors.

Thirty-day unplanned readmission in hospitalised asthma patients in the USA

IntroductionHospital quality improvement and hospital performance are commonly evaluated using parameters such as average length of stay (LOS), patient safety measures and rates of hospital readmission. Thirty-day readmission (30-DR) rates...

1250Grass pollen exposure and children’s asthma repeat admissions in Victoria, Australia

Abstract Background Paediatric asthma-related readmissions significantly challenge public health systems. As evidence suggests readmissions are possibly associated with ambient grass pollen levels, we sought to determine the relationship between grass pollen exposure and the risk of readmission for asthma among children in Victoria, Australia. Methods The Victorian Admitted Episodes Dataset 1st July 1997–30th June 2009 was used to identify primary admissions with a principal diagnosis of asthma for children aged 2-18 years. Total sample size was 48,068 admissions. Readmissions were defined as a subsequent admission within 28 days of index discharge. Multiple semi-parametric Poisson Generalized Additive Models were used to assess associations between the grass pollen season and daily grass pollen counts (lagged and cumulative) with repeat admissions, while controlling for meteorological factors and air pollutants. Results Readmissions totalled to 2,152 (4.47% of all admissions). Mean daily readmissions were 1.44 times higher during the grass pollen season (95%CI 1.03-2.02). Pollen season was associated with readmission only for the youngest age group (2-5), incident rate ratio 1.99 (95%CI 1.26-3.14). Daily readmission was non-linearly associated with same day pollen counts only for the 13-18-year age group. Lag 2 pollen counts were non-linearly associated with all daily readmissions for boys in gender-stratified and younger age groups (2-5, 6-12) in age-stratified analysis. Conclusions Grass pollen exposure was associated with higher readmission rates for paediatric asthma. Key messages Younger children and boys with severe or poorly controlled asthma need to be assessed for preventive therapies before the grass pollen season to reduce the repeat admissions.

Genetic ancestry differences in pediatric asthma readmission are mediated by socioenvironmental factors

Social and financial hardships, combined with disease managment and environmental factors explain approximately 80% of the observed disparity in asthma-related readmissions between Black and White children. We sought to determine whether asthma-related readmissions differed by degree of African ancestry and the extent to which such an association would also be explained by socioenvironmental risk factors. This study used data from a prospective cohort study of 695 Black and White children aged 1 to 16 years with an asthma-related admission. The primary outcome was a similar readmission within 12 months. Each subject's African ancestry was determined by single nucleotide polymorphisms on a continuous scale ranging from 0 to 1 (0= no African ancestry; 1= 100% African ancestry). We also assessed 37 social, environmental, and clinical variables that we clustered into 6 domains (for example, hardship, disease management). Survival and mediation analyses were conducted. A total of 134 children (19.3%) were readmitted within 12 months. Higher African ancestry was associated with asthma readmission (odds ratio 1.11, 95% confidence interval 1.05-1.18 for every 10% increase in African ancestry) with adjustment for age and gender. The association between African ancestry and readmission was mediated by hardship (sβ= 3.42, P< .001) and disease management (sβ= 0.046, P= .001), accounting for >50% of African ancestry's effect on readmission. African ancestry was no longer significantly associated with readmission (sβ= 0.035, P= .388) after accounting for these mediators. African ancestry was strongly associated with readmission, and the association was mediated by family hardship and disease management. These results are consistent with the notion that asthma-related racial disparities are driven by factors like structural racism and social adversity.

Diabetes Mellitus Is Associated with Worse Outcome in Patients Hospitalized for Asthma

Asthma is a prevalent disease with a high economic cost. More than 50% of its direct cost relates to asthma hospitalizations. Diabetes mellitus (DM) is a significant comorbidity in asthmatic patients, yet its impact on asthma-related hospitalizations is unknown. To compare the outcome of asthma-related hospitalizations in patients with and without DM. Using Healthcare Cost and Utilization Project Nationwide Readmissions Database, we analyzed data of all adults with index admission for asthma and with no other chronic pulmonary conditions, and compared outcomes between patients with and without DM. Weighted regression analysis was used to determine the impact of DM on hospitalization outcomes. All multivariate regression models were adjusted for patient demographics, socioeconomic status, and chronic medical comorbidities. A total of 717,200 asthmatic patients were included, with 202,489 (28.3%) having DM. Diabetic patients were older and had more comorbidities. When hospitalized for asthma, diabetic patients had increased hospital length of stay, cost, and risk for 30-day all-cause and asthma-related readmission. They also had a higher risk for developing nonrespiratory complications during their hospital stay compared with nondiabetic patients. The risk of mortality was similar between the 2 groups. Patients hospitalized for asthma with coexisting DM had increased hospital length of stay, cost, and risk for readmission. Interventions are urgently needed to reduce the risk for hospital admission and readmission in patients with coexisting DM and asthma. These interventions would have profound economic and societal impact.

Does participation in the community outreach for asthma care and healthy lifestyles (COACH) program alter subsequent use of hospital services for children discharged with asthma?

Introduction: Transition from hospital to home is a challenging time for children with asthma and their caregivers because of the high risk for reutilization of acute hospital services. Detecting effective quality improvement initiatives to reduce utilization of urgent services in children discharged with asthma is an important clinical and public health question. This study was designed to identify the role of a multimodal, nurse-driven, inpatient initiated Community Outreach for Asthma Care and Healthy lifestyles (COACH) program on subsequent use of hospital services for pediatric patients with asthma.Methods: We utilized comparative effectiveness design to identify the difference in recurrent emergency department (ED) visits and/or admissions within 12-months after discharge between patients with asthma who engaged in the COACH program (Intervention group) and those who did not (Comparison group). We used administrative databases of hospitals included in the Meridian Health system to identify the number of and time to asthma-related readmissions and ED re-attendances.Results: We found no difference in the rate or number of recurrent hospital-based services used within 12 months, but found a reduction in ED re-visitation and/or readmission within 30 days for COACH program participants prior to and after adjustment for age, race/ethnicity, insurance status, and clinical presentation (Odd Ratio 0.44, 95% Confidence Interval 0.20, 0.93).Conclusion: Participation in the COACH program decreases the likelihood for subsequent use of hospital services within a month of discharge for children with asthma. Enhanced post-discharge interactions with families may reduce long-term reuse of hospital-based services for COACH program participants.

Long-term asthma-related readmissions: comparison between children admitted and not admitted to the intensive care unit for critical asthma

Objectives To compare the time to asthma-related readmission between children admitted to the intensive care unit (ICU) for asthma and those with a non-ICU hospitalization in the United States and to explore risk factors associated with readmission among children admitted in the ICU. Methods In this retrospective cohort study, we included children aged 2–17 years in the State Inpatient Database (2005-2014) from four U.S. states who were hospitalized for asthma. We compared the time to asthma-related readmissions and emergency department (ED) visit between children admitted and not admitted to the ICU using the log-rank test. Among those admitted to the ICU, we explored factors associated with readmission using Cox regression. Results 66 835 children were hospitalized for asthma, with 14.0% admitted to the ICU, and 12 844 were readmitted for asthma while 22 915 had an asthma-related ED visit. The time to asthma-related readmission was shorter in the ICU group compared to the non-ICU group (p < 0.001), but the time to asthma-related ED visit did not differ between the two groups (p = 0.43). Being preschool-aged, female, Black, and having lower household income and a longer length of stay during the initial hospitalization conferred a higher risk of asthma-related readmission among children admitted to the ICU. Preschool age and Medicaid were Florida-specific risk factors while Hispanic ethnicity was New York-specific. Conclusion Compared to children not admitted to the ICU, children admitted to the ICU for asthma were at increased risk of asthma-related readmission, with certain risk factors conferring an even higher risk.

Long-term asthma-related readmission in children previously admitted to the intensive care unit for asthma

Introduction Childhood asthma is a significant public health problem in the United States, where more than 6 million children are affected by asthma. In 2011, a national survey showed that almost 611,000 Emergency Department visits and 200,000 hospital admissions annually among children are associated to asthma. There are no studies that have exhaustively described the characteristics of asthmatic pediatric patients admitted to ICUs and their long-term follow-up assessing the asthma-related readmissions. The objective of this study was to compare time to asthma-related readmission between children with a previous hospitalization for asthma requiring ICU admission and those with a non-ICU hospitalization in the United States. Methods State Inpatient Database for 4 states from 2005 to 2014 was used in a retrospective cohort study. Children aged 2–17 years were included. The index hospitalization was defined as a hospitalization with a primary diagnosis of asthma (ICD-9 code 493.XX). Time to asthma-related readmissions and the time to asthma-related ED visit that did not result in a hospitalization were recorded. The log-rank test was used to study differences in the time to readmission and ED visit between children who were admitted and those who were not admitted to the ICU during the index hospitalization. The Cox regression was used to evaluate the associated risk of some variables to the readmission, estimated by the calculation of the hazard ratio (HR) and its 95% of confidence interval. Results A total of 66,835 subjects were hospitalized. Fifteen percent of the hospitalizations required ICU admission. The mean (SD) age was 5.7 (3.8) years, with 60.5% being males. Children admitted to the ICU were older [7.1(4.3) and 6.4(4.1) years in the ICU and non-ICU groups]. A total of 12,844 children were readmitted for asthma during the study period while 22,915 had an asthma-related ED visit. The time to asthma-related readmission was lower in the ICU group compared to the non-ICU group (P Conclusion Children previously admitted to the ICU for asthma were at increased risk of asthma-related readmission, underlining the importance of the long-term follow-up of these children.

Time to asthma-related readmission in children admitted to the intensive care unit for asthma

目的 比较既往因哮喘入住ICU患儿及未在ICU住院患儿间哮喘相关再入院时间差异，了解曾于ICU住院患儿再入院时间预测因子。 设计 对泛加拿大住院患者管理数据库2008年4月1日至2014年3月31日间数据进行回顾性队列研究。 场所 全加拿大成人及儿童医院。 对象 因哮喘住院的2～17岁患儿。 干预措施 无。 测量措施和主要结果 研究期间26 168例患儿共住院33 304次。既往ICU住院患儿再入院时间短于未在ICU住院患儿(中位27月vs. 35月)。学龄前儿童(HR＝1.48，95%CI 1.02～2.14)及住院时间延长(HR＝1.63，95%CI 1.17～2.27)均与再入院时间缩短有关。 结论 相比于无需重症监护患儿，既往因哮喘入住ICU患儿因哮喘再入院时间较短，凸显此类患儿出院后长期目标导向随访的重要性。学龄前儿童及长期住院患儿远期发病风险尤高。

Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach.

Childhood asthma is characterized by disparities in the experience of morbidity, including the risk for readmission to the hospital after an initial hospitalization. African American children have been shown to have more than 2 times the hazard of readmission when compared with their white counterparts. To explain why African American children are at greater risk for asthma-related readmissions than white children. This study was completed as part of the Greater Cincinnati Asthma Risks Study, a population-based, prospective, observational cohort. From August 2010 to October 2011, it enrolled 695 children, aged 1 to 16 years, admitted for asthma or wheezing who identified as African American (n = 441) or white (n = 254) in an inpatient setting of an urban, tertiary care children's hospital. The main outcome was time to asthma-related readmission and race was the predictor. Biologic, environmental, disease management, access, and socioeconomic hardship variables were measured; their roles in understanding racial readmission disparities were conceptualized using a directed acyclic graphic. Inverse probability of treatment weighting balanced African American and white children with respect to key measured variables. Racial differences in readmission hazard were assessed using weighted Cox proportional hazards regression and Kaplan-Meier curves. The sample was 65% male (n = 450), and the median age was 5.4 years. African American children were 2.26 times more likely to be readmitted than white children (95% CI, 1.56-3.26). African American children significantly differed with respect to nearly every measured biologic, environmental, disease management, access, and socioeconomic hardship variable. Socioeconomic hardship variables explained 53% of the observed disparity (hazard ratio, 1.47; 95% CI, 1.05-2.05). The addition of biologic, environmental, disease management, and access variables resulted in 80% of the readmission disparity being explained. The difference between African American and white children with respect to readmission hazard no longer reached the level of significance (hazard ratio, 1.18; 95% CI, 0.87-1.60; Cox P = .30 and log-rank P = .39). A total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups. Such a comprehensive, well-framed approach to exposures that are associated with morbidity is critical as we attempt to better understand and lessen persistent child asthma disparities.

Asthma Care Quality Measures at Children's Hospitals and Asthma-Related Outcomes.

The Joint Commission requires hospitals to report on Children's Asthma Care (CAC) measures, although their relationship to outcomes is not clear. The objective of this study was to (1) characterize metrics hospitals use for asthma, and to (2) determine if the number and type of metrics used is associated with readmission rates. Pediatric hospital quality leaders were asked to identify asthma metrics utilized by their respective organizations via an online survey. "Use" of metrics was defined as periodically measuring data regardless of performance. Linear regression was used to determine if the number or domain of metrics grouped by topic used was associated with 7-, 30-, and 90-day same-cause readmission rates obtained from the Pediatric Health Information System (PHIS). Among respondents (n = 27, 62.7%), the mean number of metrics used was 20.5 (SD = 9.1, range = 4-38). There was no association between the number or domain type of metrics used and 7-, 30-, or 90-day readmission rates. Despite using a wide variety of asthma metrics, there was no association between use of any metric or domain of metrics and asthma-related readmission rates. Additional work should identify asthma process measures that are associated with meaningful outcomes.

Routinely sleeping away from home and the association with child asthma readmission.

The increased prevalence of transitions between households may have implications for child asthma morbidity. We, therefore, sought to enumerate the prevalence of regularly spending nights sleeping away from home among children admitted to the hospital for asthma and to examine the relationship of nights away to asthma-related readmission. This was a population-based, prospective cohort of 774 children, aged 1-16years, who were admitted with asthma or bronchodilator-responsive wheezing and enrolled in the Greater Cincinnati Asthma Risks Study. The study took place at Cincinnati Children's Hospital Medical Center, an urban, academic children's hospital in the Midwest. The primary exposure was regularly spending nights away from home. Selected covariates included caregiver marital status, shift work, child's race, income, psychological distress, and running out of/not having medications on hand. The primary outcome was asthma-related readmission within 12months. A total of 19% were readmitted within 12months. The 33% of children that spent ≥1 night away from home per week were significantly more likely to be readmitted than those who spent no nights away (25% vs. 16%, p=0.002). Spending nights away from home [adjusted relative risk (aRR) 1.5, 95% confidence interval (CI) 1.2-2.0] and lower income (aRR 2.6, 95% CI 1.1-6.4) were the strongest independent predictors of readmission after adjusting for child age, gender, and race, and caregiver marital status, shift work, risk of psychological distress, and running out of meds. Increased awareness of the multiple settings in which children with asthma live may help shape more comprehensive approaches to asthma care.

Hospital-Level Compliance With Asthma Care Quality Measures at Children's Hospitals and Subsequent Asthma-Related Outcomes

The Children's Asthma Care (CAC) measure set evaluates whether children admitted to hospitals with asthma receive relievers (CAC-1) and systemic corticosteroids (CAC-2) and whether they are discharged with a home management plan of care (CAC-3). It is the only Joint Commission core measure applicable to evaluate the quality of care for hospitalized children. To evaluate longitudinal trends in CAC measure compliance and to determine if an association exists between compliance and outcomes. Cross-sectional study using administrative data and CAC compliance data for 30 US children's hospitals. A total of 37,267 children admitted with asthma between January 1, 2008, and September 30, 2010, with follow-up through December 31, 2010, accounted for 45,499 hospital admissions. Hospital-level CAC measure compliance data were obtained from the National Association of Children's Hospitals and Related Institutions. Readmission and postdischarge emergency department (ED) utilization data were obtained from the Pediatric Health Information System. Children's Asthma Care measure compliance trends; postdischarge ED utilization and asthma-related readmission rates at 7, 30, and 90 days. The minimum quarterly CAC-1 and CAC-2 measure compliance rates reported by any hospital were 97.1% and 89.5%, respectively. Individual hospital CAC-2 compliance exceeded 95% for 97.9% of the quarters. Lack of variability in CAC-1 and CAC-2 compliance precluded examination of their association with the specified outcomes. Mean CAC-3 compliance was 40.6% (95% CI, 34.1%-47.1%) and 72.9% (95% CI, 68.8%-76.9%) for the initial and final 3 quarters of the study, respectively. The mean 7-, 30-, and 90-day postdischarge ED utilization rates were 1.5% (95% CI, 1.3%-1.6%), 4.3% (95% CI, 4.0%-4.5%), and 11.1% (95% CI, 10.5%-11.7%) and the mean quarterly 7-, 30-, and 90-day readmission rates were 1.4% (95% CI, 1.2%-1.6%), 3.1% (95% CI, 2.8%-3.3%), and 7.6% (95% CI, 7.2%-8.1%). There was no significant association between overall CAC-3 compliance (odds ratio [OR] for 5% improvement in compliance) and postdischarge ED utilization rates at 7 days (OR, 1.00; 95% CI, 0.98-1.02), 30 days (OR, 0.97; 95% CI, 0.90-1.04), and 90 days (OR, 0.96; 95% CI, 0.77-1.18). In addition, there was no significant association between overall CAC-3 compliance (OR for 5% improvement in compliance) and readmission rates at 7 days (OR, 1.00; 95% CI, 0.99-1.02), 30 days (OR, 0.99; 95% CI, 0.96-1.02), and 90 days (OR, 1.01; 95% CI, 0.90-1.12). Among children admitted to pediatric hospitals for asthma, there was high hospital-level compliance with CAC-1 and CAC-2 quality measures and moderate compliance with the CAC-3 measure but no association between CAC-3 compliance and subsequent ED visits and asthma-related readmissions.

Association between allergic rhinitis and hospital resource use among asthmatic children in Norway

Preliminary evidence suggests that inadequately controlled allergic rhinitis in asthmatic patients can contribute towards increased asthma exacerbations and poorer symptom control, which may increase medical resource use. The objective of this study was therefore to assess the effect of concomitant allergic rhinitis on asthma-related hospital resource utilization among children below 15 years of age with asthma in Norway. A population-based retrospective cohort study of children (aged 0-14 years) with asthma was conducted using data from a patient-specific public national database of hospital admissions during a 2-year period, 1998-1999. Multivariate linear regression, adjusting for risk factors including age, gender, year of admission, urban/rural residence and severity of asthma episode, estimated the association between allergic rhinitis and total hospital days. A multivariate Cox proportional-hazards model estimated relative hazard of readmission according to concomitant allergic rhinitis status. Among 2961 asthmatic children under 15 years of age with at least one asthma-related hospital admission over a 2-year period, 795 (26.8%) had a recorded history of allergic rhinitis. Asthmatic children with allergic rhinitis had a 1.72-times greater hazard of asthma-related readmissions than asthmatic children without allergic rhinitis. Multivariate analysis revealed that history of concomitant allergic rhinitis was a significant predictor of increased number of hospital days per year (least-squares mean difference 0.23 days, P < 0.05). Concomitant allergic rhinitis in asthmatic children was associated with increased likelihood of asthma-related hospital readmissions and greater total hospital days.