Principal Diagnosis Of Asthma Research Articles

Selection of Representative Questionnaire Items from the Asthma Control Test.

Asthma is a disease characterized by the appearance of transient or persistent symptoms in response to allergens, viral upper respiratory infections, and cold air. Asthma treatment aims to control, rather than cure, and digital systems can be useful in this regard. However, conventional assessment methods for asthma control are not suitable for digital healthcare. Therefore, we aimed to select representative questionnaire items suitable for digitally assessing the asthma control status. We analyzed the Asthma Control Test (ACT) and selected representative items. Throughout the year 2020, ACT results (2019 in total) collected from patients (>18 years old) with a principal diagnosis of asthma were analyzed. Individual questionnaire items were tested using Pearson’s correlation and receiver operating characteristic curves. Of the five questionnaire items, Q1, Q2, Q3, and Q5 yielded significant findings. Among these questionnaires, Q2 was the most descriptive and correlated questionnaire. Q5 was also significant but it was excluded since it was unable to apply to the digital health care system for asthma assessment method. The remaining three questionnaire items were selected and their sensitivity and specificity were assessed. Eight methods were analyzed, and the sum of scores of Q1−Q3 had the highest sensitivity and specificity (97% and 91%, respectively). The results suggested that, instead of the full items of ACT, the sum of Q1−Q3 can be used to assess the asthma control status. These findings will serve as the foundation for developing digital asthma control assessment tools.

Grass pollen exposure is associated with higher readmission rates for pediatric asthma.

Pediatric asthma hospital readmission is a burden on the individual and costly for Australian hospitals. Grass pollen's role, a known trigger for asthma admissions, is unexamined in readmissions. We examined the association between grass pollen and pediatric asthma readmission. The Victorian Admitted Episodes Dataset was used to identify all primary admissions with a principal diagnosis of asthma in children aged 2-18 years between 1997 and 2009. Readmissions were defined as subsequent admissions within 28 days of index admission discharge. Generalized additive models were used to assess associations between readmission, grass pollen season, and daily grass pollen counts, lagged and cumulative. Models were further stratified by sex and age group. Mean daily readmission was higher during grass pollen season than other times of the year, incidence rate ratio (IRR) 1.44 (95% CI, 1.03, 2.02) and for children aged 2-5 years, IRR 1.99 (1.26, 3.14). Same day grass pollen was nonlinearly associated with daily readmission for the 13-18 age group between 110 and 256 grains/m3 , p < .01. Lag 2 grass pollen was nonlinearly associated with daily readmissions overall (p=.03), boys (p=.01), and younger age groups 2-5 (p=.02) and 6-12 (p < .001). Grass pollen exposure was associated with higher readmission rates for pediatric asthma. Treatment plans prior to discharge could be implemented to reduce the likelihood of readmission by younger children during the pollen season.

Cost analysis of hospitals performing continuous albuterol in non-intensive care settings

Objective To compare hospital costs and resource utilization for pediatric asthma admissions based on the hospitals’ availability of continuous albuterol aerosolization administration (CAA) in non-intensive care unit (ICU) settings. Methods We conducted a retrospective cohort study of children ages 2-17 years admitted in 2019 with a principal diagnosis of asthma using the Pediatric Health Information System. Hospitals and hospitalizations were categorized based on location of CAA administration, ICU-only versus general inpatient floors. Hospitals preforming CAA in an intermediate care unit were excluded. We calculated total cost, standardized unit costs and rates of interventions. Groups were compared using Chi-Square, t-test and Wilcoxon rank-sum test as indicated. A log linear mixed model was created to evaluate potential confounders. Results Twenty-one hospitals (7084 hospitalizations) allowed CAA on the floor. Twenty-four hospitals (6100 hospitalizations) allowed CAA in the ICU-only. Median total cost was $4639 (Interquartile Range (IQR) $3060–$7512) for the floor group and $5478 (IQR $3444–$8539) for the ICU-only group (p < 0.001) (mean cost difference of $775 per patient). Hospitalization costs were $4,726,829 (95% CI $3,459,920–$5,993,860) greater for the children treated at hospitals restricting CAA to the ICU. We observed higher standardized laboratory, imaging, clinical and other unit costs, along with higher use of interventions in the ICU-only group. After adjustment, we found that ICU stay and hospital LOS were the main drivers of cost difference between the groups. Conclusions There was cost savings and decreased resource utilization for hospitals that performed CAA on the floor. Further studies exploring variations in asthma management are warranted.

Gastroesophageal Reflux Disease (GERD) Is Associated with Worse Outcomes in Patients with Asthma Presenting to the Emergency Department

Introduction: Gastroesophageal Reflux Disease (GERD) is a leading cause of chronic cough. Recent data show that GERD may be present in up to 70% of patients with asthma. Some have implicated both acid and non-acid reflux as an etiological factor in the bronchoconstriction associated with asthma. Furthermore, asthma guidelines recommend management of GERD as a way to treat poorly controlled asthma. However, given the limited body of literature in this field, experts now suggest that GERD may only be a small contributing factor in the pathophysiological mechanisms of asthma. Methods: We performed a retrospective review of the data in the 2013 National Emergency Database Sample (NEDS) to evaluate whether a diagnosis of GERD is associated with a worsening of outcomes in patients presenting to the Emergency Department (ED) with a principal diagnosis of asthma. These outcomes include hospitalization rate, health care utilization rates, length of stay, and cost visits. Results: There were a total of 440,381 ED visits with principal diagnosis of asthma in the United States. 54.3% of the patients were female, and mean (SD) age at visit was 32(16). In 20,610 (4.7%) of these visits diagnosis of GERD was also recorded for the patient. After adjusting for age, sex, and number of diagnoses, GERD was associated with an increased the risk of admission by 23% (RR 1.21, 95% CI 1.16-1.26,p < 0.001). A diagnosis GERD was also associated with a lower cost of medical care, with an average savings of $4,973 per patient (95% CI 5668-4277, p < 0.001). GERD was associated with significantly more frequent use of nebulizers in the ED (RR 1.24, 95%CI 1.12-1.39, p < 0.001) and chest Computed Tomography (CT) scans (RR 1.66, 95%CI 1.05-2.62, p=0.029), but not with use of chest radiographs (RR 1.05, 95%CI 0.94-1.17, p=0.425). GERD was also associated with a shorter hospital stay, leading to an average difference of about 8 hours comparing patients with GERD and those without (RR 0.28, 95%CI 0.35-0.22,p < 0.001). Conclusion: Our data show that GERD may play a large role in asthma exacerbations and visits to the ED. Furthermore, compared to those without GERD, patients with asthma who have GERD tend to need more diagnostic testing, hospital admissions, and increased costs of health care.

Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma

To study the comparative effectiveness of dexamethasone vs prednisone/prednisolone in children hospitalized with asthma exacerbation not requiring intensive care. This multicenter retrospective cohort study, using the Pediatric Health Information System, included children aged 4-17 years who were hospitalized with a principal diagnosis of asthma between January 1, 2007 and December 31, 2012. Children with chronic complex condition and/or initial intensive care unit (ICU) management were excluded. Propensity score matching was used to detect differences in length of stay (LOS), readmissions, ICU transfer, and cost between groups. 40,257 hospitalizations met inclusion criteria; 1166 (2.9%) received only dexamethasone. In the matched cohort (N = 1284 representing 34 hospitals), the LOS was significantly shorter in the dexamethasone group compared with the prednisone/prednisolone group. The proportion of subjects with a LOS of 3 days or more was 6.7% in the dexamethasone group and 12% in the prednisone/prednisolone group (P = .002). Differences in all-cause readmission at 7- and 30 days were not statistically significant. The dexamethasone group had lower costs of index admission ($2621 vs $2838; P < .001) and total episode of care (including readmissions) ($2624 vs $2856; P < .001) compared with the prednisone/prednisolone group. There were no clinical significant differences in ICU transfer or readmissions between groups. Dexamethasone may be considered an alternative to prednisone/prednisolone for children hospitalized with asthma exacerbation not requiring admission to intensive care.

Stable admission rate for acute asthma in Danish children since 1977.

Childhood asthma is consistently reported to have increased in recent decades in most westernized countries, but it is unknown if this increase is similar across severities. We aimed to study the time-trend of acute hospital admission and readmission for asthma of school-aged children in the recent 35 years in Denmark. We analyzed time-trends in the national incidence rate of hospitalization for acute severe asthma in children aged 5-15 in Denmark during the 35-year period 1977-2012 in the Danish national registry. Only in-patient admissions with a principal diagnosis of asthma (ICD-8: 493** or ICD-10: J45** or J46**) were included. Among children with asthma hospitalizations, we investigated the risk of readmission beyond 1 month of first admission. Admissions were summarized as rates per thousand person years at risk. The overall time-trend is stable with a rate of one admission per year per thousand children at risk and a per-year incidence rate ratio 0.999 [95 % CI 0.997-1.001]. The rate of any readmission decreased from approximately 20 per thousand children in the eighties to less than 10 in the early nineties before stabilizing at around 10 per thousand children from mid-nineties and onwards. During 35 years of nation-wide follow-up, we find a highly stable incidence rate of first hospital admission for acute severe asthma in children. Moreover, rates of readmission halved during the seventies and stabilized in the last twenty years. In conclusion, our data suggest that the reported increase in childhood asthma is mainly due to less severe cases.

Increasing use of non-invasive ventilation in asthma: a long-term analysis of the Portuguese national hospitalization database

Objectives: To describe the use and outcomes of non-invasive positive pressure ventilation (NPPV) and invasive ventilation (IV) in adults hospitalized for acute asthma exacerbations in Portugal. Methods: We analyzed the hospitalizations of adults with a principal diagnosis of asthma in mainland Portugal between 2000 and 2010. The data source was the national hospitalizations database, which includes administrative and clinical data produced by physicians trained in coding. Results: Ventilation support was used in 5.1% (n = 747) of the 14 515 hospitalizations with a principal diagnosis of asthma: NPPV in 1.7% (n = 241) and IV in 3.5% (n = 506); NPPV use increased from 1% in 2000 to 3.3% in 2010. In patients with asthma, the ratio of NPPV use to IV use increased from 0.27 to 1.06. This increase was observed even after exclusion of secondary diagnoses in which NPPV is frequently used. The mortality rate was 1.5% for all asthma hospitalizations: 2.5% when NPPV was used and 15.8% for those requiring IV. Conclusions: The use of ventilation support in asthma remained stable over time; however, the use of non-invasive ventilation has increased. Still, we do not have good data regarding the effectiveness of non-invasive ventilation when treating asthma exacerbations. Therefore, additional studies are much needed and should assess physiologic and clinical variables that might affect the effectiveness of non-invasive ventilation in patients with asthma exacerbations.

Does initial length of stay impact 30-day readmission risk in pediatric asthma patients?

Objectives: Accountable care puts pressure on hospitals to manage care episodes. Initial length of stay (ILOS) and readmission risk are important elements of a care episode and measures of care quality. Understanding the association between these two measures can guide hospital efforts in managing care episodes. This study was designed to explore the association between ILOS and readmission risk in a cohort of pediatric asthma patients. Materials and methods: The sample cohort (n = 4965) consisted of all asthma patients discharged from Children’s Hospitals and Clinics of Minnesota (CHC MN) from January 2008 through August 2012. Asthma discharges included cases with a principal diagnosis of asthma or certain respiratory cases with asthma listed as a secondary diagnosis. Multiple logistic regression was used to test associations, adjusting for covariates. Results: Adjusting for covariates, we found no significant association between ILOS and readmission (OR: 1.04 [95% CI: 0.98–1.10]). Analyzing ILOS categorically by length of stay, one-day stays did not have a significantly higher readmission risk (OR:1.27 [95% CI: 0.87–1.85]) than two-day stays, which had the lowest observed readmission risk. Risk increased as ILOS exceeded two days but was not significantly different by day. We found no association when comparing the difference in actual versus expected ILOS and readmission risk (shorter than expected OR: 1.13 [95% CI: 0.74–1.71]; longer than expected OR: 0.97 [95% CI: 0.69–1.38]). Conclusions: Attempts to prolong ILOS would dramatically increase costs with little impact on readmissions. For example, increasing one-day visits to two-day visits would increase hospital patient days 38% (1870 d) in this cohort while decreasing total readmissions by 3.8% [95% CI: 3.6–4.0%]. Understanding the mechanisms that impact readmissions is essential in evaluating cost-effective approaches to improving patient outcomes and lowering the cost of care.

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Quality of care for acute asthma in 63 US emergency departments

Little is known about the quality of acute asthma care in the emergency department (ED). We sought to determine the concordance of ED management of acute asthma with National Institutes of Health asthma guidelines, to identify ED characteristics predictive of higher guideline concordance, and to assess whether guideline concordance was associated with hospital admission. We conducted a retrospective chart review study of acute asthma as part of the National Emergency Department Safety Study. Using a principal diagnosis of asthma, we identified ED visits for acute asthma in 63 urban EDs in 23 US states between 2003 and 2006. Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores both at the patient and ED level. These scores ranged from 0 to 100, with 100 indicating perfect concordance. The cohort consisted of 4,053 subjects; their median age was 34 years, and 64% were women. The overall patient guideline concordance score was 67 (interquartile range, 63-83), and the ED concordance score was 71 (SD, 7). Multivariable analysis showed southern EDs were associated with lower ED concordance scores (beta-coefficient, -8.2; 95% CI, -13.8 to -2.7) compared with northeastern EDs. After adjustment for the severity on ED presentation, patients who received all recommended treatments had a 46% reduction in the risk of hospital admission compared with others. Concordance with treatment recommendations in the National Institutes of Health asthma guidelines was moderate. Significant variations in ED quality of asthma care were found, and geographic differences existed. Greater concordance with guideline-recommended treatments might reduce hospitalizations.

Childhood Asthma Surveillance using Administrative Data: Consistency between Medical Billing and Hospital Discharge Diagnoses

The absence of ongoing surveillance for childhood asthma in Montreal, Quebec, prompted the present investigation to assess the validity and practicality of administrative databases as a foundation for surveillance. To explore the consistency between cases of asthma identified through physician billings compared with hospital discharge summaries. Rates of service use for asthma in 1998 among Montreal children aged one, four and eight years were estimated. Correspondence between the two databases (physician billing claims versus medical billing claims) were explored during three different time periods: the first day of hospitalization, during the entire hospital stay, and during the hospital stay plus a one-day margin before admission and after discharge ('hospital stay +/- 1 day'). During 1998, 7.6% of Montreal children consulted a physician for asthma at least once and 0.6% were hospitalized with a principal diagnosis of asthma. There were no contemporaneous physician billings for asthma 'in hospital' during hospital stay +/- 1 day for 22% of hospitalizations in which asthma was the primary diagnosis recorded at discharge. Conversely, among children with a physician billing for asthma 'in hospital', 66% were found to have a contemporaneous in-hospital record of a stay for 'asthma'. Both databases of hospital and medical billing claims are useful for estimating rates of hospitalization for asthma in children. The potential for diagnostic imprecision is of concern, especially if capturing the exact number of uses is more important than establishing patterns of use.

Asthma hospitalization patterns in young children relating to admission age, infection presence, sex, and race

Although childhood hospitalizations for asthma are common, there are few detailed temporal and demographic descriptions of these hospitalizations. To relate temporal patterns of asthma hospitalization in young children to admission age, sex, comorbid infection, and race. Retrospective analysis of 151,391 New York State hospitalizations with a principal diagnosis of asthma between January 1, 1990, and December 31, 2004, in children younger than 5 years. Admission patterns across time were related to admission age, sex, race, and comorbid diagnoses of common infections. Although the overall hospitalization rate decreased, it was still 63.8 per 10,000 in 2004. Higher hospitalization rates were consistently observed in children younger than 3 years, African Americans, and boys. Fall increases and summer declines in overall monthly hospitalization rates and monthly median ages exemplified the seasonality observed in the study population. However, admissions with concomitant common infections peaked in the winter, not fall months. Sex did not affect the observed seasonality. Compared with white patients, African Americans not only manifested more than 3-fold higher hospitalization rates but also more repeated hospitalizations. The concurrent cyclical increases in median age and monthly admissions suggest that seasonal factors affecting older children may relate to fall increases in asthma admissions. These fall peaks are not accounted for by recognizable concomitant common respiratory tract infections. Understanding the basis for these seasonal variations may lead to prevention strategies that could decrease asthma admissions. Asthma hospitalizations in young children continued to be highly prevalent in New York State, especially in African American patients.

Length of Stay and Costs for Asthma Patients by Hospital Characteristics—A Five-Year Population-Based Analysis

This study sets out to explore the relationship between hospital characteristics, asthma length of stay (LOS), and costs per discharge. The study adopts hospitalization data from the Taiwan National Health Insurance Research Database covering the period from 1997 to 2001. Study subjects were identified from the database by principal diagnosis of asthma or asthmatic bronchitis, with a total of 139,630 cases being included in the study. Multiple-regression analyses were performed to explore the relationship between LOS, costs per discharge and hospital characteristics, adjusting for age, gender, and discharge status of patients, as well as complications or comorbidities. The regression analyses showed that, compared with district hospitals, medical centers and regional hospitals have longer and more statistically significant LOS, as well as higher costs. Hospitals operating on a for-profit basis have shorter LOS and lower costs than public and not-for-profit hospitals. This study shows the existence of wide variations in LOS and costs per discharge for asthma hospitalizations, between the various types of hospitals in Taiwan.

The Association Between Hospital Readmission and Insurance Provider Among Adults with Asthma

Context. Asthma is ranked as the ninth most common chronic condition in the U.S., and its annual direct costs from hospital services alone are estimated at $3.1 billion. Hospitalization rates due to asthma reveal several disparities and may be attributed to recent changes in the healthcare delivery system, including the penetration of managed care. Objective. To examine the relationship between 7‐day hospital readmission and insurance provider among adults with asthma. Design. A retrospective cohort study that included patients aged 18–64 with a principal diagnosis of asthma, who were discharged from acute nonfederal hospitals in New Jersey between 1 January 1993 and 31 December 1996. In the absence of unique patient identifiers, a linkage system was used to match subsequent readmissions for the same patient to the first admission. Main Outcome Measure. Seven‐day readmission. Results. Results showed a significantly increased risk of 7‐day readmission for managed care patients as compared to indemnity patients (OR = 1.67, 1.10–2.53). Shorter lengths of stay were associated with greater odds of readmission (LOS = 0: OR = 5.17, 2.49–10.75, LOS = 1: OR = 2.30, 1.30–4.07). Conclusions. Managed care patients have shorter lengths of stay as compared to indemnity patients, which leads to an increased risk of returning to the hospital within a short period of time. In trying to provide cost‐effective patient care, we may be discharging patients prematurely.

Asthma severity among children hospitalized in 1990 and 1995.

During the past decade, the number of children with asthma increased; however, the number of asthma hospitalizations for children decreased. To assess the proportion of high-severity cases among children hospitalized with asthma and the association of high-severity asthma with patient and hospital characteristics. The data set used was the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Records were selected of patients 18 years and younger who had the principal diagnosis of asthma. Records were analyzed of 29077 patients at 746 hospitals in 1990 and 33 443 patients at 811 hospitals in 1995. Asthma severity was classified by All Patient Refined-Diagnosis-Related Groups. Cross-sectional logistic regression analysis was performed using survey data analysis software. The most common diagnoses associated with high-severity asthma were respiratory distress and respiratory failure. The proportion of high-severity asthma cases did not change significantly between 1990 (4.2%) and 1995 (4.6%) (P = .08). Adolescents and boys were more likely to have high-severity asthma than children aged 5 to 12 years and girls. Western, southern, and north-central hospitals and urban teaching hospitals had a higher proportion of high-severity asthma cases than northeastern hospitals and nonteaching hospitals. Between 1990 and 1995, the proportion of high-severity cases among children hospitalized with asthma did not change significantly. However, patient age, sex, region of the country, and hospital teaching status were associated with variations in the proportion of high-severity asthma cases.