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Skeen EH, Moore CM, Federico MJ, Seibold MA, Liu AH, Hamlington KL. The Child Opportunity Index 2.0 and exacerbation-prone asthma in a cohort of urban children. Pediatr Pulmonol 2024; 59:1894-1904. [PMID: 38558492 DOI: 10.1002/ppul.26998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
RATIONALE Social determinants of health underlie disparities in asthma. However, the effects of individual determinants likely interact, so a summary metric may better capture their impact. The Child Opportunity Index 2.0 (COI) is one such tool, yet its association with exacerbation-prone (EP) asthma is unknown. OBJECTIVE To investigate the association between the COI and EP asthma and clinical measures of asthma severity in children. METHODS We analyzed data from two prospective observational pediatric asthma cohorts (n = 193). Children were classified as EP (≥1 exacerbation in the past 12 months) or exacerbation-null (no exacerbations in the past 5 years). Spirometry, exhaled nitric oxide, IgE, and Composite Asthma Severity Index (CASI) were obtained. The association between COI and EP status was assessed with logistic regression. We fit linear and logistic regression models to test the association between COI and each clinical measure. RESULTS A 20-point COI decrease conferred 40% higher odds of EP asthma (OR 1.4; 95%CI 1.1-1.76). The effect was similar when adjusted for age and sex (OR 1.38, 95%CI 1.1-1.75) but was attenuated with additional adjustment for race and ethnicity (OR 1.19, 95%CI 0.92-1.54). A similar effect was seen for the Social/Economic and Education COI domains but not the Health/Environment Domain. A 20-point COI decrease was associated with an increase in CASI of 0.34. COI was not associated with other clinical measures. CONCLUSIONS Lower COI was associated with greater odds of EP asthma. This highlights the potential use of the COI to understand neighborhood-level risk and identify community targets to reduce asthma disparities.
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Affiliation(s)
- Emily H Skeen
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Monica J Federico
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max A Seibold
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Andrew H Liu
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katharine L Hamlington
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
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Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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Thavamani A, Velayuthan S, Patel D, Al-Hammadi N, Sferra TJ, Sankararaman S. Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome. Am J Gastroenterol 2023; 118:1439-1445. [PMID: 37052354 DOI: 10.14309/ajg.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. METHODS We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. RESULTS We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. DISCUSSION Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sujithra Velayuthan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Navanandan N, Florin TA, Leonard J, Ramgopal S, Cotter JM, Shah SS, Ruddy RM, Ambroggio L. Impact of Adjunct Corticosteroid Therapy on Quality of Life for Children With Suspected Pneumonia. Pediatr Emerg Care 2023; 39:482-487. [PMID: 37306694 PMCID: PMC10351650 DOI: 10.1097/pec.0000000000002984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine the association between adjunct corticosteroid therapy and quality of life (QoL) outcomes in children with signs and symptoms of lower respiratory tract infection and clinical suspicion for community-acquired pneumonia (CAP) in the emergency department (ED). METHODS Secondary analysis from a prospective cohort study of children aged 3 months to 18 years with signs and symptoms of LRTI and a chest radiograph for suspected CAP in the ED, excluding children with recent (within 14 days) systemic corticosteroid use. The primary exposure was receipt of corticosteroids during the ED visit. Outcomes were QoL measures and unplanned visits. Multivariable regression was used to evaluate the association between corticosteroid therapy and outcomes. RESULTS Of 898 children, 162 (18%) received corticosteroids. Children who received corticosteroids were more frequently boys (62%), Black (45%), had history of asthma (58%), previous pneumonia (16%), presence of wheeze (74%), and more severe illness at presentation (6%). Ninety-six percent were treated for asthma as defined by report of asthma or receipt of ß-agonist in the ED. Receipt of corticosteroids was not associated with QoL measures: days of activity missed (adjusted incident rate ratio [aIRR], 0.84; 95% confidence interval [CI], 0.63-1.11) and days of work missed (aIRR, 0.88; 95% CI, 0.60-1.27). There was a statistically significant interaction between age (>2 years) and corticosteroids receipt; the patients had fewer days of activity missed (aIRR, 0.62; 95% CI, 0.46-0.83), with no effect on children 2 years or younger (aIRR, 0.83; 95% CI, 0.54-1.27). Corticosteroid treatment was not associated with unplanned visit (odds ratio, 1.37; 95% CI, 0.69-2.75). CONCLUSIONS In this cohort of children with suspected CAP, receipt of corticosteroids was associated with asthma history and was not associated with missed days of activity or work, except in a subset of children aged older than 2 years.
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Affiliation(s)
- Nidhya Navanandan
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Todd A. Florin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jan Leonard
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Sriram Ramgopal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jillian M. Cotter
- Section of Pediatric Hospital Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Samir S. Shah
- Division of Hospital Medicine and Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Richard M. Ruddy
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lilliam Ambroggio
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO
- Section of Pediatric Hospital Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, CO
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Akin-Imran A, Bajpai A, McCartan D, Heaney LG, Kee F, Redmond C, Busby J. Ethnic variation in asthma healthcare utilisation and exacerbation: systematic review and meta-analysis. ERJ Open Res 2023; 9:00591-2022. [PMID: 37143831 PMCID: PMC10152257 DOI: 10.1183/23120541.00591-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 05/06/2023] Open
Abstract
Background Patients from ethnic minority groups (EMGs) frequently report poorer asthma outcomes; however, a broad synthesis summarising ethnic disparities is yet to be undertaken. What is the magnitude of ethnic disparities in asthma healthcare utilisation, exacerbations and mortality? Methods MEDLINE, Embase and Web of Science databases were searched for studies reporting ethnic variation in asthma healthcare outcomes (primary care attendance, exacerbation, emergency department (ED) visits, hospitalisation, hospital readmission, ventilation/intubation and mortality) between White patients and those from EMGs. Estimates were displayed using forest plots and random-effects models were used to calculate pooled estimates. We conducted subgroup analyses to explore heterogeneity, including by specific ethnicity (Black, Hispanic, Asian and other). Results 65 studies, comprising 699 882 patients, were included. Most studies (92.3%) were conducted in the United States of America (USA). Patients from EMGs had evidence suggestive of lower levels of primary care attendance (OR 0.72, 95% CI 0.48-1.09), but substantially higher ED visits (OR 1.74, 95% CI 1.53-1.98), hospitalisations (OR 1.63, 95% CI 1.48-1.79) and ventilation/intubation (OR 2.67, 95% CI 1.65-4.31) when compared to White patients. In addition, we found evidence suggestive of increased hospital readmissions (OR 1.19, 95% CI 0.90-1.57) and exacerbation rates (OR 1.10, 95% CI 0.94-1.28) among EMGs. No eligible studies explored disparities in mortality. ED visits were much higher among Black and Hispanic patients, while Asian and other ethnicities had similar rates to White patients. Conclusions EMGs had higher secondary care utilisation and exacerbations. Despite the global importance of this issue, the majority of studies were performed in the USA. Further research into the causes of these disparities, including whether these vary by specific ethnicity, is required to aid the design of effective interventions.
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Affiliation(s)
- AbdulQadr Akin-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Achint Bajpai
- University of Central Lancashire, University of Central Lancashire Faculty of Clinical and Biomedical Sciences, Preston, UK
| | - Dáire McCartan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liam G. Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Corresponding author: John Busby ()
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Aggarwal S, Cepalo T, Gill S, Thipse M, Clifton KL, Higginson A, Vu J, Bijelić V, Barrowman N, Giangioppo S, Radhakrishnan D. Factors associated with future hospitalization among children with asthma: a systematic review. J Asthma 2023; 60:425-445. [PMID: 35522051 DOI: 10.1080/02770903.2022.2070762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit. DATA SOURCES We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models. RESULTS Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67-5.61), pets exposure (OR = 1.67 95%CI 1.17-2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95-4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity. CONCLUSIONS We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.
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Affiliation(s)
| | - Tanita Cepalo
- Faculty of Science, Carleton University, Ottawa, Canada
| | - Sana Gill
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Madhura Thipse
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Kerry-Lee Clifton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - James Vu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Vid Bijelić
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Sandra Giangioppo
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada.,ICES, Ottawa, ON, Canada
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Batra M, Dharmage SC, Newbigin E, Tang M, Abramson MJ, Erbas B, Vicendese D. Grass pollen exposure is associated with higher readmission rates for pediatric asthma. Pediatr Allergy Immunol 2022; 33:e13880. [PMID: 36433858 DOI: 10.1111/pai.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Mehak Batra
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Newbigin
- School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital Victoria, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Engineering & Mathematical Science, La Trobe University, Bundoora, Victoria, Australia
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The Relationship Between Insurance Status and the Affordable Care Act on Asthma Outcomes Among Low-Income US Adults. Chest 2022; 161:1465-1474. [DOI: 10.1016/j.chest.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/17/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
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Calcaterra V, Nappi RE, Farolfi A, Tiranini L, Rossi V, Regalbuto C, Zuccotti G. Perimenstrual Asthma in Adolescents: A Shared Condition in Pediatric and Gynecological Endocrinology. CHILDREN 2022; 9:children9020233. [PMID: 35204953 PMCID: PMC8870409 DOI: 10.3390/children9020233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022]
Abstract
Asthma is a frequent medical condition in adolescence. The worsening of the most common symptoms perimenstrually is defined as perimenstrual asthma (PMA). The cause of PMA remains unclear, but a role for hormonal milieu is plausible. Data on PMA in adolescents are limited, and its management is not fully established. We aimed to discuss the PMA phenomenon in young females from pathophysiology to preventive strategies, focusing on the relationship with the hormonal pattern. The fluctuation of estrogens at ovulation and before menstruation and the progesterone secretion during the luteal phase and its subsequent withdrawal seem to be the culprits, because the deterioration of asthma is cyclical during the luteal phase and/or during the first days of the menstrual cycle. Conventional asthma therapies are not always effective for PMA. Preventive strategies may include innovative hormonal contraception. Even a possible beneficial effect of other hormonal treatments, including estrogens, progestogens, and androgens, as well as leukotriene receptor antagonists and explorative approach using microbial-directed therapy, is considered. The underlying mechanisms, through which sex-hormone fluctuations influence asthma symptoms, represent a challenge in the clinical management of such a distressing condition. Further studies focused on young females are mandatory to promote adolescent health.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.F.); (V.R.); (G.Z.)
- Correspondence:
| | - Rossella Elena Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.E.N.); (L.T.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Andrea Farolfi
- Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.F.); (V.R.); (G.Z.)
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (R.E.N.); (L.T.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.F.); (V.R.); (G.Z.)
| | - Corrado Regalbuto
- Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy; (A.F.); (V.R.); (G.Z.)
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20157 Milano, Italy
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10
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Redmond C, Akinoso-Imran AQ, Heaney LG, Sheikh A, Kee F, Busby J. Socioeconomic disparities in asthma health care utilization, exacerbations, and mortality: A systematic review and meta-analysis. J Allergy Clin Immunol 2021; 149:1617-1627. [PMID: 34673047 DOI: 10.1016/j.jaci.2021.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies investigating the effect of socioeconomic status (SES) on asthma health care outcomes have been heterogeneous in the populations studied and methodologies used. OBJECTIVE We sought to systematically synthesize evidence investigating the impact of SES on asthma health care utilization, exacerbations, and mortality. METHODS We searched Embase, Medline, and Web of Science for studies reporting differences in primary care attendance, exacerbations, emergency department attendance, hospitalization, ventilation/intubation, readmission, and asthma mortality by SES. Study quality was assessed using the Newcastle Ottawa Scale, and meta-analyses were conducted using random-effects models. We conducted several prespecified subgroup analyses, including by health care system (insurance based vs universal government funded) and time period (before vs after 2010). RESULTS A total of 61 studies, comprising 1,145,704 patients, were included. Lower SES was consistently associated with increased secondary health care utilization including emergency department attendance (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), hospitalization (OR, 1.63; 95% CI, 1.34-1.99), and readmission (OR, 1.31; 95% CI, 1.19-1.44). Substantial associations were also found between SES and ventilation/intubation (OR, 1.76; 95% CI, 1.13-2.73), although there was no association with primary care attendances (OR, 0.79; 95% CI, 0.51-1.24). We found evidence of borderline significance for increased exacerbations (OR, 1.18; 95% CI, 0.98-1.42) and mortality (OR, 1.12; 95% CI, 0.92-1.37) among more deprived groups. There was no convincing evidence that disparities were associated with country-level health care funding models or that disparities have narrowed over time. CONCLUSIONS Patients with a lower SES have substantially increased secondary care health care utilization. We found evidence suggestive of increased exacerbations and mortality risk, although CIs were wide. These disparities have been consistently reported worldwide, including within countries offering universally funded health care systems. Systematic review registration: CRD42020173544.
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Affiliation(s)
- Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Abdul Qadr Akinoso-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
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11
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Xiong R, Zhao Z, Lu H, Ma Y, Zeng H, Chen Y. Asthma Patients Benefit More Than Chronic Obstructive Pulmonary Disease Patients in the Coronavirus Disease 2019 Pandemic. Front Med (Lausanne) 2021; 8:709006. [PMID: 34568369 PMCID: PMC8460914 DOI: 10.3389/fmed.2021.709006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has raised many questions about the role of underlying chronic diseases on disease outcomes. However, there is limited information about the effects of COVID-19 on chronic airway diseases. Therefore, we conducted the present study to investigate the impact of COVID-19 on patients with asthma or chronic obstructive pulmonary disease (COPD) and ascertain risk factors for acute exacerbations (AEs). Methods: This single-center observational study was conducted at the Second Xiangya Hospital of Central South University, involving asthma or COPD patients who had been treated with inhaled combination corticosteroids (ICSs), such as budesonide, and one long-acting beta-2-agonist (LABA), such as formoterol, for at least a year before the COVID-19 pandemic. We conducted telephone interviews to collect demographic information and clinical data between January 1, 2019, and December 31, 2020, focusing on respiratory and systemic symptoms, as well as times of exacerbations. Data for asthma and COPD were then compared, and the risk factors for AEs were identified using logistic regression analysis. Results: A total of 251 patients were enrolled, comprising 162 (64.5%) who had asthma and 89 who had COPD, with none having COPD/asthma overlap. Frequency of AEs among asthma patients was significantly lower in 2020 than in 2019 (0.82 ± 3.33 vs. 1.00 ± 3.16; P < 0.05). Moreover, these patients visited the clinic less (0.37 ± 0.93 vs. 0.49 ± 0.94; P < 0.05) and used emergency drugs less (0.01 ± 0.11 vs. 007 ± 0.38; P < 0.05) during the COVID-19 pandemic. In contrast, among COPD patients, there were no significant differences in AE frequency, clinic visits, or emergency drug use. Furthermore, asthma patients visited clinics less frequently during the pandemic than those with COPD. Logistic regression analysis also showed that a history of at least one AE within the last 12 months was associated with increased AE odds for both asthma and COPD during the COVID-19 pandemic (odds ratio: 13.73, 95% CI: 7.04-26.77; P < 0.01). Conclusion: During the COVID-19 pandemic, patients with asthma showed better disease control than before, whereas patients with COPD may not have benefited from the pandemic. For both diseases, at least one AE within the previous 12 months was a risk factor for AEs during the pandemic. Particularly, among asthma patients, the risk factors for AE during the COVID-19 pandemic were urban environment, smoking, and lower asthma control test scores.
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Affiliation(s)
- Ruoyan Xiong
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Zhiqi Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Huanhuan Lu
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
- Research Unit of Respiratory Diseases, Central South University, Changsha, China
- Hunan Centre for Evidence-Based Medicine, Changsha, China
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12
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Hogan AH, Carroll CL, Iverson MG, Hollenbach JP, Philips K, Saar K, Simoneau T, Sturm J, Vangala D, Flores G. Risk Factors for Pediatric Asthma Readmissions: A Systematic Review. J Pediatr 2021; 236:219-228.e11. [PMID: 33991541 DOI: 10.1016/j.jpeds.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically review the literature on pediatric asthma readmission risk factors. STUDY DESIGN We searched PubMed/MEDLINE, CINAHL, Scopus, PsycINFO, and Cochrane Central Register of Controlled Trials for published articles (through November 2019) on pediatric asthma readmission risk factors. Two authors independently screened titles and abstracts and consensus was reached on disagreements. Full-text articles were reviewed and inclusion criteria applied. For articles meeting inclusion criteria, authors abstracted data on study design, patient characteristics, and outcomes, and 4 authors assessed bias risk. RESULTS Of 5749 abstracts, 74 met inclusion criteria. Study designs, patient populations, and outcome measures were highly heterogeneous. Risk factors consistently associated with early readmissions (≤30 days) included prolonged length of stay (OR range, 1.1-1.6) and chronic comorbidities (1.7-3.2). Risk factors associated with late readmissions (>30 days) included female sex (1.1-1.6), chronic comorbidities (1.5-2), summer discharge (1.5-1.8), and prolonged length of stay (1.04-1.7). Across both readmission intervals, prior asthma admission was the most consistent readmission predictor (1.3-5.4). CONCLUSIONS Pediatric asthma readmission risk factors depend on the readmission interval chosen. Prior hospitalization, length of stay, sex, and chronic comorbidities were consistently associated with both early and late readmissions. TRIAL REGISTRATION CRD42018107601.
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Affiliation(s)
- Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
| | - Christopher L Carroll
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Division of Critical Care, Connecticut Children's Medical Center, Hartford, CT
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Asthma Center, Connecticut Children's Medical Center, Hartford, CT
| | - Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, NY; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Katarzyna Saar
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Tregony Simoneau
- Boston Children's Medical Center, Boston, MA; Department of Pediatrics, Harvard University, Cambridge, MA
| | - Jesse Sturm
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT
| | - Divya Vangala
- Department of Pediatrics, Duke University, Durham, NC
| | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, FL
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13
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Chan M, Gray M, Burns C, Owens L, Jaffe A, Homaira N. Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma. J Asthma Allergy 2021; 14:797-808. [PMID: 34262298 PMCID: PMC8274827 DOI: 10.2147/jaa.s311721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/05/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia. Methods A cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services. Results A total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81–96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4–91.3) and between EDs and paediatric wards (p=9.4×10−9); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2–3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up. Conclusion There are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.
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Affiliation(s)
- Mei Chan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Melinda Gray
- Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Christine Burns
- Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Louisa Owens
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Nusrat Homaira
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
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14
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Tiwari A, Wang AL, Li J, Lutz SM, Kho AT, Weiss ST, Tantisira KG, McGeachie MJ. Seasonal Variation in miR-328-3p and let-7d-3p Are Associated With Seasonal Allergies and Asthma Symptoms in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:576-588. [PMID: 34212545 PMCID: PMC8255344 DOI: 10.4168/aair.2021.13.4.576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE MicroRNAs (miRs) are small non-coding RNA molecules of around 18-22 nucleotides that are key regulators of many biologic processes, particularly inflammation. The purpose of this study was to determine the association of circulating miRs from asthmatic children with seasonal variation in allergic inflammation and asthma symptoms. METHODS We used available small RNA sequencing on blood serum from 398 children with mild-to-moderate asthma from the Childhood Asthma Management Program. We used seasonal asthma symptom data at the study baseline and allergen affection status from baseline skin prick tests as primary outcomes. We identified differentially expressed (DE) miRs between pairs of seasons using DESeq2. Regression analysis was used to identify associations between allergy status to specific seasonal allergens and DE miRs in 4 seasons and between seasonal asthma symptom data and DE miRs. We performed pathway enrichment analysis for target genes of the DE miRs using DAVID. RESULTS After quality control, 398 samples underwent differential analysis between the 4 seasons. We found 52 unique miRs from a total of 81 DE miRs across seasons. Further investigation of the association between these miRs and sensitization to seasonal allergens using skin prick tests revealed that 26 unique miRs from a total of 38 miRs were significantly associated with a same-season allergen. Comparison between seasonal asthma symptom data revealed that 2 of these 26 miRs also had significant associations with asthma symptoms in the same seasons: miR-328-3p (P < 0.03) and let-7d-3p (P < 0.05). Enrichment analysis showed that the most enriched pathway clusters were Rap1, Ras, and MAPK signaling pathways. CONCLUSION Our results show seasonal variation in miR-328-3p and let-7d-3p are significantly associated with seasonal asthma symptoms and seasonal allergies. These indicate a potentially protective role for let-7d-3p and a deleterious role for miR-328-3p in asthmatics sensitized to mulberry. Further work will determine whether these miRs are drivers or results of the allergic response.
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Affiliation(s)
- Anshul Tiwari
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alberta L Wang
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jiang Li
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sharon M Lutz
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Alvin T Kho
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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15
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Predicting Severe Asthma Exacerbations in Children: Blueprint for Today and Tomorrow. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2619-2626. [PMID: 33831622 DOI: 10.1016/j.jaip.2021.03.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Severe asthma exacerbations are the primary cause of morbidity and mortality in children with asthma. Accurate prediction of children at risk for severe exacerbations, defined as those requiring systemic corticosteroids, emergency department visit, and/or hospitalization, would considerably reduce health care utilization and improve symptoms and quality of life. Substantial progress has been made in identifying high-risk exacerbation-prone children. Known risk factors for exacerbations include demographic characteristics (ie, low income, minority race/ethnicity), poor asthma control, environmental exposures (ie, aeroallergen exposure/sensitization, concomitant viral infection), inflammatory biomarkers, genetic polymorphisms, and markers from other "omic" technologies. The strongest risk factor for a future severe exacerbation remains having had one in the previous year. Combining risk factors into composite scores and use of advanced predictive analytic techniques such as machine learning are recent methods used to achieve stronger prediction of severe exacerbations. However, these methods are limited in prediction efficiency and are currently unable to predict children at risk for impending (within days) severe exacerbations. Thus, we provide a commentary on strategies that have potential to allow for accurate and reliable prediction of children at risk for impending exacerbations. These approaches include implementation of passive, real-time monitoring of impending exacerbation predictors, use of population health strategies, prediction of severe exacerbation responders versus nonresponders to conventional exacerbation management, and considerations for preschool-age children who can be especially high risk. Rigorous prediction and prevention of severe asthma exacerbations is needed to advance asthma management and improve the associated morbidity and mortality.
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16
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Baek J, Kash BA, Xu X, Benden M, Roberts J, Carrillo G. Pediatric asthma hospitalization: individual and environmental characteristics of high utilizers in South Texas. J Asthma 2020; 59:94-104. [PMID: 32962451 DOI: 10.1080/02770903.2020.1827424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Few studies have examined factors affecting the high frequency of hospitalization for pediatric asthma. This study identifies individual and environmental characteristics of children with asthma from a low-income community with a high number of hospitalizations. METHODS The study population included 902 children admitted at least once to a children's hospital in South Texas because of asthma from 2010 to 2016. The population was divided into three groups by utilization frequency (high: ≥4 times, medium: 2-3 times, or low: 1 time). Individual-level factors at index admission and environmental factors were included for the analysis. Unadjusted and adjusted multivariate ordered logistic regression models were applied to identify significant characteristics of high hospital utilizers. RESULTS The high utilization group comprised 2.4% of total patients and accounted for substantial hospital resource utilization: 10.8% of all admissions and 13.5% of days stayed in the hospital. Patients in the high utilization group showed longer length of stay (LOS) and shorter time between admissions on average than the other two groups. The multivariate ordered logistic regression models revealed that age of 5-11 years (OR = 0.57, 95%CI = 0.35-0.93), longer LOS (2 days: OR = 1.80, 95%CI = 1.15-2.84; ≥3 days: OR = 3.38, 95%CI = 2.10-5.46), warm season at index admission (OR = 1.49, 95%CI = 1.01-2.20), and higher average ozone level in children's residential neighborhoods (OR = 1.78, 95%CI = 1.01-3.14) were significantly associated with a higher number of asthma hospitalizations. CONCLUSIONS The findings suggest the importance of monitoring high hospital utilizers and establishing strategies for such patients based on their characteristics to reduce repeated hospitalizations and to increase optimal use of hospital resources.
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Affiliation(s)
- Juha Baek
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Bita A Kash
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA.,Center for Health & Nature, Houston Methodist Research Institute, Houston, TX, USA.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Mark Benden
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Jon Roberts
- Department of Pediatric Pulmonology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
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17
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Philips KS, Reiss DE, Silver EJ, Rastogi D. Readmission and Ambulatory Health Care Use After Asthma Hospitalization Among Urban Minority Children. Hosp Pediatr 2020; 10:338-346. [PMID: 32205397 PMCID: PMC7106775 DOI: 10.1542/hpeds.2019-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Kaitlyn S Philips
- The Children's Hospital at Montefiore, Bronx, New York; and
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel E Reiss
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Ellen J Silver
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Deepa Rastogi
- The Children's Hospital at Montefiore, Bronx, New York; and
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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18
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Nkoy FL, Fassl BA, Wilkins VL, Johnson J, Unsicker EH, Koopmeiners KJ, Jensen A, Frazier M, Gaddis J, Malmgren L, Williams S, Oldroyd H, Greene T, Sheng X, Uchida DA, Maloney CG, Stone BL. Ambulatory Management of Childhood Asthma Using a Novel Self-management Application. Pediatrics 2019; 143:peds.2018-1711. [PMID: 31097465 DOI: 10.1542/peds.2018-1711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric ambulatory asthma control is suboptimal, reducing quality of life (QoL) and causing emergency department (ED) and hospital admissions. We assessed the impact of the electronic-AsthmaTracker (e-AT), a self-monitoring application for children with asthma. METHODS Prospective cohort study with matched controls. Participants were enrolled January 2014 to December 2015 in 11 pediatric clinics for weekly e-AT use for 1 year. Analyses included: (1) longitudinal changes for the child (QoL, asthma control, and interrupted and missed school days) and parents (interrupted and missed work days and satisfaction), (2) comparing ED and hospital admissions and oral corticosteroid (OCS) use pre- and postintervention, and (3) comparing ED and hospital admissions and OCS use between e-AT users and matched controls. RESULTS A total of 327 children and parents enrolled; e-AT adherence at 12 months was 65%. Compared with baseline, participants had significantly (P < .001) increased QoL, asthma control, and reduced interrupted and missed school and work days at all assessment times. Compared with 1 year preintervention, they had reduced ED and hospital admissions (rate ratio [RR]: 0.68; 95% confidence interval [CI]: 0.49-0.95) and OCS use (RR: 0.74; 95% CI: 0.61-0.91). Parent satisfaction remained high. Compared with matched controls, participants had reduced ED and hospital admissions (RR: 0.41; 95% CI: 0.22-0.75) and OCS use (RR: 0.65; 95% CI: 0.46-0.93). CONCLUSIONS e-AT use led to high and sustained participation in self-monitoring and improved asthma outcomes. Dissemination of this care model has potential to broadly improve pediatric ambulatory asthma care.
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Affiliation(s)
- Flory L Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, Utah;
| | - Bernhard A Fassl
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | | | - Eun Hea Unsicker
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | | | | | | | | | | | - Heather Oldroyd
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Tom Greene
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Xiaoming Sheng
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Derek A Uchida
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Bryan L Stone
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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19
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Gross E, Lee DS, Hotz A, Ngo KC, Rastogi D. Impact of Obesity on Asthma Morbidity During a Hospitalization. Hosp Pediatr 2018; 8:538-546. [PMID: 30154081 DOI: 10.1542/hpeds.2017-0265] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma and obesity are 2 common pediatric problems. Obesity is a known risk factor for asthma, and obese children with asthma have higher disease burden. However, little is known on how obesity in urban minority children, mainly Hispanic and African American children, impacts morbidity during pediatric asthma hospitalizations. METHODS A retrospective chart review was conducted on children and adolescents age 2 to 18 years hospitalized at the Children's Hospital at Montefiore for an acute asthma exacerbation. We elucidated the association of overweight or obese status with severity of the exacerbation, quantified by length of stay (LOS) and need for intensive care management. Multivariate analysis was conducted to identify independent predictors of LOS. RESULTS A total of 975 children met the inclusion criteria, of whom 55% were normal weight and 45% were overweight or obese. Sixty percent were Hispanic, and 37% were African American. The overall average LOS was 2.57 days (range: 0.67-12.92). Overweight or obese status was associated with a higher asthma severity at baseline (P = .021). Overweight or obese children had a longer average LOS compared with normal weight children (2.75 vs 2.39 days; P < .01) with more PICU stays (P = .006), even after adjustment for higher baseline asthma severity. The severity of the exacerbation did not differ by ethnicity. CONCLUSIONS Obesity in children hospitalized for asthma is associated with more severe asthma exacerbations, longer LOS, and increased use of PICU level care, independent of their higher baseline disease severity and ethnicity.
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Affiliation(s)
- Elissa Gross
- Children's Hospital at Montefiore, Bronx, New York; .,Albert Einstein College of Medicine, Bronx, New York; and
| | - Diana S Lee
- Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York; and
| | - Arda Hotz
- Boston Children's Hospital, Boston, Massachusetts
| | - Kim Chi Ngo
- Albert Einstein College of Medicine, Bronx, New York; and
| | - Deepa Rastogi
- Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York; and
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20
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Jean T, Yang SJ, Crawford WW, Takahashi SH, Sheikh J. Development of a pediatric asthma predictive index for hospitalization. Ann Allergy Asthma Immunol 2018; 122:283-288. [PMID: 30476547 DOI: 10.1016/j.anai.2018.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Variation in emergency department (ED) management for asthma exacerbation leads to disparities in care. Current asthma severity scores are insufficient to be used for hospitalization decisions. OBJECTIVE To develop and internally validate an asthma predictive index for hospitalization (APIH) to guide practitioners in their admission decision for children with asthma exacerbations. METHODS Data were collected from 12,066 children between 5 and 18 years old diagnosed with asthma exacerbation in the ED. Epidemiologic findings, number of inhaled corticosteroid canisters, short-acting β-blocker canisters, oral steroids, coexisting atopy, family history of atopy, insurance, and prior asthma ED visits or hospitalizations were compared between patients hospitalized and discharged. We used univariate analysis and multivariate analysis to determine the best predictor variables for hospitalization. Our study internally validated the prediction index to estimate future performance of the prediction rule. RESULTS The highest risk factors associated with asthma hospitalization from the ED are oxygen saturation less than 94%, respiratory rate greater than 31/min, history of pneumonia, and asthma ED visits in past 12 months. With a reduced predictive model that combined these risk factors, the odds ratio was 44.9 (95% CI, 32.8-61.4), which is extremely significant. Our C index of discrimination of 0.77 was similar to the validation C index of 0.78, which confirms a solid prediction model. CONCLUSION We have developed and internally validated a pediatric hospitalization prediction index for acute asthma exacerbation in the ED. Further studies are needed to externally validate the APIH before its implementation into clinical practice.
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Affiliation(s)
- Tiffany Jean
- Department of Allergy and Immunology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
| | - Su-Jau Yang
- Department of Research and Evaluation, Kaiser Permanente, Los Angeles, California
| | - William W Crawford
- Department of Allergy and Immunology, Kaiser Permanente South Bay Medical Center, Harbor City, California
| | - Scott H Takahashi
- Department of Pediatric Ambulatory Care Pharmacy, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Javed Sheikh
- Department of Allergy and Immunology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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21
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Shin EK, Mahajan R, Akbilgic O, Shaban-Nejad A. Sociomarkers and biomarkers: predictive modeling in identifying pediatric asthma patients at risk of hospital revisits. NPJ Digit Med 2018; 1:50. [PMID: 31304329 PMCID: PMC6550159 DOI: 10.1038/s41746-018-0056-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 11/09/2022] Open
Abstract
The importance of social components of health has been emphasized both in epidemiology and public health. This paper highlights the significant impact of social components on health outcomes in a novel way. Introducing the concept of sociomarkers, which are measurable indicators of social conditions in which a patient is embedded, we employed a machine learning approach that uses both biomarkers and sociomarkers to identify asthma patients at risk of a hospital revisit after an initial visit with an accuracy of 66%. The analysis has been performed over an integrated dataset consisting of individual-level patient information such as gender, race, insurance type, and age, along with ZIP code-level sociomarkers such as poverty level, blight prevalence, and housing quality. Using this uniquely integrated database, we then compare the traditional biomarker-based risk model and the sociomarker-based risk model. A biomarker-based predictive model yields an accuracy of 65% and the sociomarker-based model predicts with an accuracy of 61%. Without knowing specific symptom-related features, the sociomarker-based model can correctly predict two out of three patients at risk. We systematically show that sociomarkers play an important role in predicting health outcomes at the individual level in pediatric asthma cases. Additionally, by merging multiple data sources with detailed neighborhood-level data, we directly measure the importance of residential conditions for predicting individual health outcomes.
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Affiliation(s)
- Eun Kyong Shin
- 1Department of Pediatrics, University of Tennessee Health Science Center - Oak Ridge National Laboratory- (UTHSC-ORNL), Center for Biomedical Informatics, Memphis, TN USA
| | - Ruhi Mahajan
- 1Department of Pediatrics, University of Tennessee Health Science Center - Oak Ridge National Laboratory- (UTHSC-ORNL), Center for Biomedical Informatics, Memphis, TN USA
| | - Oguz Akbilgic
- 1Department of Pediatrics, University of Tennessee Health Science Center - Oak Ridge National Laboratory- (UTHSC-ORNL), Center for Biomedical Informatics, Memphis, TN USA.,2Department of Preventive Medicine, UTHSC, Memphis, TN USA
| | - Arash Shaban-Nejad
- 1Department of Pediatrics, University of Tennessee Health Science Center - Oak Ridge National Laboratory- (UTHSC-ORNL), Center for Biomedical Informatics, Memphis, TN USA
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22
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Ardura-Garcia C, Stolbrink M, Zaidi S, Cooper PJ, Blakey JD. Predictors of repeated acute hospital attendance for asthma in children: A systematic review and meta-analysis. Pediatr Pulmonol 2018; 53:1179-1192. [PMID: 29870146 PMCID: PMC6175073 DOI: 10.1002/ppul.24068] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front-line clinicians' decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature. METHODS We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma. RESULTS Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission. CONCLUSION Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re-attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.
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Affiliation(s)
| | | | - Seher Zaidi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philip J Cooper
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
| | - John D Blakey
- Respiratory Medicine, Royal Liverpool Hospital, Liverpool, UK.,Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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23
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Krupp NL, Weist A, Fiscus CD, Slaven J, Harner A, Montgomery GS, Howenstine MS. Efficacy, cost effectiveness, and sustainability of a pediatric high risk asthma clinic. Pediatr Pulmonol 2018; 53:538-543. [PMID: 29484838 DOI: 10.1002/ppul.23967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/24/2018] [Indexed: 11/06/2022]
Abstract
AIM At our institution, a pediatric High Risk Asthma clinic has been in operation for over 15 years, targeting children with poorly controlled, and difficult to treat asthma. This study evaluates the outcomes and cost-effectiveness of the High Risk Asthma clinic from 2000 through 2014. METHODS A retrospective chart review was performed on all patients entering High Risk Asthma clinic from 2000-2014, and total hospitalizations and Emergency Department visits were tallied for the year prior to entering clinic and the year after. Costs incurred, and reimbursements obtained from payors were tallied to determine cost-effectiveness and sustainability. RESULTS Consistent decreases in hospitalizations (51.2% decrease, P < 0.001) and Emergency Department visits (23.0% decrease, P = 0.048) were seen for patients entering High Risk Asthma clinic, with commensurate significant decreases in related costs. Reimbursements received for outpatient services were sufficient to offset operational costs of the High Risk Asthma clinic, when both clinic visit, and pulmonary function testing charges were included. CONCLUSIONS A pediatric High Risk Asthma clinic model is efficacious in decreasing hospitalizations and Emergency Department visits for a difficult to treat population, and such a model can be cost-effective and sustainable.
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Affiliation(s)
- Nadia L Krupp
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrea Weist
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cindy D Fiscus
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - James Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew Harner
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Gregory S Montgomery
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michelle S Howenstine
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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24
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Kenyon CC, Gruschow SM, Quarshie WO, Griffis H, Leach MC, Zorc JJ, Bryant-Stephens TC, Miller VA, Feudtner C. Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders. J Asthma 2018; 56:95-103. [PMID: 29437489 DOI: 10.1080/02770903.2018.1424195] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the feasibility of a mobile health, inhaled corticosteroid (ICS) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma. METHODS Children aged 2-13 with persistent asthma were enrolled in this pilot randomized controlled trial during an asthma emergency department (ED) visit or hospitalization. Intervention arm participants received daily text message reminders for 30 days, and both arms received electronic sensors to measure ICS use. Primary outcomes were feasibility of sensor use and text message acceptability. Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories. Group-based trajectory modeling was used to examine adherence trajectories. RESULTS Forty-one participants (mean age 5.9) were randomized to intervention (n = 21) or control (n = 20). Overall, 85% were Black, 88% had public insurance, and 51% of the caregivers had a high school education or less. Thirty-two participant families (78%) transmitted medication adherence data; of caregivers who completed the acceptability survey, 25 (96%) chose to receive daily reminders beyond that study interval. Secondary outcome analyses demonstrated similar average daily adherence between groups (intervention = 36%; control = 32%, P = 0.73). Three adherence trajectories were identified with none ever exceeding 80% adherence. CONCLUSIONS Within a high-risk pediatric cohort, electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants, but there was no signal of effect. Adherence trajectories following severe exacerbation were suboptimal, demonstrating an important opportunity for asthma care improvement.
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Affiliation(s)
- Chén C Kenyon
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
| | - Siobhan M Gruschow
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - William O Quarshie
- c Healthcare Analytics Unit , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Heather Griffis
- c Healthcare Analytics Unit , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Michelle C Leach
- d Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , Pennsylvania
| | - Joseph J Zorc
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
| | - Tyra C Bryant-Stephens
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Victoria A Miller
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
| | - Chris Feudtner
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
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25
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Silva VLSD, França GVAD, Santos IS, Barros FC, Matijasevich A. Characteristics and factors associated with hospitalization in early childhood: 2004 Pelotas (Brazil) birth cohort. CAD SAUDE PUBLICA 2017; 33:e00035716. [PMID: 29116316 DOI: 10.1590/0102-311x00035716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 01/06/2017] [Indexed: 11/22/2022] Open
Abstract
Hospitalization is a frequent event in early childhood. In Brazil, the National Household Sample Survey of 2008 showed a 9% hospitalization rate among children in the first four years of life. The study aimed to describe the characteristics of hospitalization in the first six years of life and analyze the early factors associated with hospitalization in a birth cohort in southern Brazil. A zero-inflated Poisson model was used to simultaneously examine the effects of co-variables for the occurrence of a given event and to count events. The frequency of at least one episode of hospitalization during the study period was 33.4% (95%CI: 31.8-34.9), and was highest in the first year (19.1%; 95%CI: 17.9-20.4), remaining stable at approximately 10% between the first and fourth years, decreasing to 8.4% (95%CI: 7.6-9.4) between the fourth and sixth years. diseases of the respiratory system were among the leading causes of hospitalization, followed by infectious and parasitic diseases. History of prior hospitalization was one of the most important predictors of odds of hospitalization and risk of multiple hospitalizations. In early childhood, birth weight, gestational age, Apgar score, sex, and type of pregnancy were inversely associated with hospitalization, and environmental characteristics such as maternal smoking in pregnancy, mother's skin color, and low family income were associated statistically with number of hospitalizations. The results point to the importance of focusing efforts on reducing hospitalizations from diseases of the respiratory system, especially in children under one year.
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Affiliation(s)
| | | | - Iná S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Fernando C Barros
- Programa de Pós-graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brasil
| | - Alícia Matijasevich
- Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brasil
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26
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Kercsmar CM, Beck AF, Sauers-Ford H, Simmons J, Wiener B, Crosby L, Wade-Murphy S, Schoettker PJ, Chundi PK, Samaan Z, Mansour M. Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community. JAMA Pediatr 2017; 171:1072-1080. [PMID: 28975221 PMCID: PMC5710369 DOI: 10.1001/jamapediatrics.2017.2600] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Asthma is the most common chronic condition of childhood. Hospitalizations and emergency department (ED) visits for asthma are more frequently experienced by minority children and adolescents and those with low socioeconomic status. OBJECTIVE To reduce asthma-related hospitalizations and ED visits for Medicaid-insured pediatric patients residing in Hamilton County, Ohio. DESIGN, SETTING, AND PARTICIPANTS From January 1, 2010, through December 31, 2015, a multidisciplinary team used quality-improvement methods and the chronic care model to conduct interventions in inpatient, outpatient, and community settings in a large, urban academic pediatric hospital in Hamilton County, Ohio. Children and adolescents aged 2 to 17 years who resided in Hamilton County, had a diagnosis of asthma, and were Medicaid insured were studied. INTERVENTIONS Interventions were implemented in 3 phases: hospital-based inpatient care redesign, outpatient-based care enhancements, and community-based supports. Plan-do-study-act cycles allowed for small-scale implementation of change concepts and rapid evaluation of how such tests affected processes and outcomes of interest. MAIN OUTCOMES AND MEASURES The study measured asthma-related hospitalizations and ED visits per 10 000 Medicaid-insured pediatric patients. Data were measured monthly on a rolling 12-month mean basis. Data from multiple previous years were used to establish a baseline. Data were tracked with annotated control charts and with interrupted time-series analysis. RESULTS Of the estimated 36 000 children and adolescents with asthma in Hamilton County (approximately 13 000 of whom are Medicaid insured and 6000 of whom are cared for in Cincinnati Children's Hospital primary care practices), asthma-related hospitalizations decreased from 8.1 (95% CI, 7.7-8.5) to 4.7 (95% CI, 4.3-5.1) per 10 000 Medicaid patients per month by June 30, 2014, a 41.8% (95% CI, 41.7%-42.0%) relative reduction. Emergency department visits decreased from 21.5 (95% CI, 20.6-22.3) to 12.4 (95% CI, 11.5-13.2) per 10 000 Medicaid patients per month by June 30, 2014, a 42.4% (95% CI, 42.2%-42.6%) relative reduction. Improvements were sustained for the subsequent 12 months. The proportion of patients who were rehospitalized or had a return ED visit for asthma within 30 days of an index hospitalization was reduced from 12% to 7%. The proportion of patients with documented well-controlled asthma in this study's primary care population increased from 48% to 54%. CONCLUSIONS AND RELEVANCE An integrated, multilevel approach focused on enhancing availability and accessibility of treatments, removing barriers to adherence, mitigating multidomain risks, augmenting self-management, and creating a collaborative relationship between the family and the health care system was associated with improved asthma outcomes for a population of Medicaid-insured pediatric patients. Similar models used in accountable care organizations or across patient panels and with other chronic conditions could be feasible and warrant evaluation.
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Affiliation(s)
- Carolyn M. Kercsmar
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | | | - Jeffrey Simmons
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Brandy Wiener
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Lisa Crosby
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Pavan K. Chundi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Zeina Samaan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Mona Mansour
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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27
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Veeranki SP, Ohabughiro MU, Moran J, Mehta HB, Ameredes BT, Kuo YF, Calhoun WJ. National estimates of 30-day readmissions among children hospitalized for asthma in the United States. J Asthma 2017; 55:695-704. [PMID: 28837382 DOI: 10.1080/02770903.2017.1365888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Previous single-center studies have reported that up to 40% of children hospitalized for asthma will be readmitted. The study objectives are to investigate the prevalence and timing of 30-day readmissions in children hospitalized with asthma, and to identify factors associated with 30-day readmissions. METHODS Data (n = 12,842) for children aged 6-18 years hospitalized for asthma were obtained from the 2013 Nationwide Readmission Database (NRD). The primary study outcome was time to readmission within 30 days after discharge attributable to any cause. Several predictors associated with the risk of admission were included: patient (age, sex, median household income, insurance type, county location, and pediatric chronic complex condition), admission (type, day, emergency services utilization, length of stay (LOS), and discharge disposition), and hospital (ownership, bed size, and teaching status). Cox's proportional hazards model was used to identify predictors. RESULTS Of 12,842 asthma-related index hospitalizations, 2.5% were readmitted within 30-days post-discharge. Time to event models identified significantly higher risk of readmission among asthmatic children aged 12-18 years, those who resided in micropolitan counties, those with >4-days LOS during index hospitalization, those who were hospitalized in an urban hospital, who had unfavorable discharge (hazard ratio 2.53, 95% confidence interval 1.33-4.79), and those who were diagnosed with a pediatric complex chronic condition, respectively, than children in respective referent categories. CONCLUSION A multi-dimensional approach including effective asthma discharge action plans and follow-up processes, home-based asthma education, and neighborhood/community-level efforts to address disparities should be integrated into the routine clinical care of asthma children.
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Affiliation(s)
- Sreenivas P Veeranki
- a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - Michael U Ohabughiro
- b School of Medicine , University of Texas Medical Branch , Galveston , TX , USA
| | - Jacob Moran
- a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - Hemalkumar B Mehta
- c Department of Surgery , University of Texas Medical Branch , Galveston , TX , USA
| | - Bill T Ameredes
- d Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine , University of Texas Medical Branch , Galveston , TX , USA
| | - Yong-Fang Kuo
- a Department of Preventive Medicine and Community Health , University of Texas Medical Branch , Galveston , TX , USA
| | - William J Calhoun
- d Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine , University of Texas Medical Branch , Galveston , TX , USA
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28
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Krupp NL, Fiscus C, Webb R, Webber EC, Stanley T, Pettit R, Davis A, Hollingsworth J, Bagley D, McCaskey M, Stevens JC, Weist A, Cristea AI, Warhurst H, Bauer B, Saysana M, Montgomery GS, Howenstine MS, Davis SD. Multifaceted quality improvement initiative to decrease pediatric asthma readmissions. J Asthma 2017; 54:911-918. [PMID: 28118056 DOI: 10.1080/02770903.2017.1281294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. METHODS Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. RESULTS From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. CONCLUSION A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.
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Affiliation(s)
- Nadia L Krupp
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Cindy Fiscus
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Russell Webb
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Emily C Webber
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.,b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Teresa Stanley
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Rebecca Pettit
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Ashley Davis
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Judy Hollingsworth
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Deborah Bagley
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Marjorie McCaskey
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - John C Stevens
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Andrea Weist
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - A Ioana Cristea
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Heather Warhurst
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Benjamin Bauer
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.,b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Michele Saysana
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Gregory S Montgomery
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Michelle S Howenstine
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Stephanie D Davis
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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Association between Postdischarge Oral Corticosteroid Prescription Fills and Readmission in Children with Asthma. J Pediatr 2017; 180:163-169.e1. [PMID: 27769549 DOI: 10.1016/j.jpeds.2016.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/11/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the relationships between postdischarge emergency department visits, oral corticosteroid (OCS) use, and 15- to 90-day asthma readmission in children. STUDY DESIGN Retrospective study of 9288 children from 12 states in the Truven MarketScan Database, ages 2-18 years, hospitalized between January 1, 2009, and June 30, 2011, with asthma, and continuously enrolled in Medicaid for 6 months prior and 3 months after hospitalization. The primary outcome was 15- to 90-day readmission for asthma. Secondary outcomes were postdischarge emergency department visits (within 28 days) and outpatient OCS prescription fills (6-28 days postdischarge or earlier if coinciding with an outpatient asthma visit). Logistic regression was used to assess the relationship of hospital readmission with patient characteristics and asthma health services surrounding the index admission. RESULTS Median age at index admission was 6 years (IQR, 3-9); 62% were male and 49% were black; 2.8% had a 15- to 90-day readmission (median, 50 days; IQR, 32-70). After index discharge, 4% had an emergency department visit (median, 17 days; IQR, 12-24) and 11% had an outpatient OCS fill (median, 14 days; IQR, 6-21). In multivariable analysis, children with a postdischarge outpatient OCS fill (OR, 3.2; 95% CI, 2.4-4.6) or hospitalization within 6 months preceding the index admission (OR, 2.9; 95% CI, 2.0-4.0) had the greatest likelihood for hospital readmission. CONCLUSIONS OCS fill within 28 days of hospital discharge was most strongly associated with 15- to 90-day hospital readmission. This finding may inform evolving strategies to reduce asthma readmissions in children.
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30
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Hall AB, Novotny A, Bhisitkul DM, Melton J, Regan T, Leckie M. Association of emergency department albuterol dispensing with pediatric asthma revisits and readmissions. J Asthma 2016; 54:498-503. [PMID: 27715361 DOI: 10.1080/02770903.2016.1236942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although pediatric asthma continues to be a highly studied disease, data to suggest clear strategies to decrease asthma related revisits or readmissions is lacking. The purpose of our study was to assess the effect of emergency department (ED) direct dispensing of beta-agonist metered dose inhalers on pediatric asthma ED revisit and readmission rates. METHODS We conducted a retrospective cohort study of pediatric patients discharged from the pediatric ED with a diagnosis of asthma. Our primary outcome measured the rate of asthma revisits to the ED or admissions to the hospital within 28 days. Logistic regression analysis was used to assess ED beta-agonist MDI dispensing and revisit and/or readmission as the outcome. RESULTS A total of 853 patients met eligibility for inclusion in the study, with 657 enrolled in the Baseline group and 196 enrolled in the ED-MDI group. The Baseline group experienced a revisit and readmission rate of 7.0% (46/657) versus 2.6% (5/196) in the ED-MDI group, (p = 0.026). ED direct dispensing of MDIs was found to be independently associated with a decreased risk of revisit or readmission (odds ratio 0.37; 95% confidence interval 0.14-0.95). CONCLUSIONS In our study, ED direct dispensing of beta-agonist MDIs resulted in a reduction in 28-day revisit and readmission to the hospital. Further studies should be performed to evaluate the economic impact of reducing these revisits and readmissions against the costs of maintaining a dispensing program. Our findings may support modification of asthma programs to include dispensing MDIs from the emergency department.
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Affiliation(s)
- A Brad Hall
- a Department of Emergency Medicine , Lakeland Regional Health , Lakeland , FL , USA
| | - April Novotny
- a Department of Emergency Medicine , Lakeland Regional Health , Lakeland , FL , USA
| | - Donna M Bhisitkul
- a Department of Emergency Medicine , Lakeland Regional Health , Lakeland , FL , USA
| | - James Melton
- a Department of Emergency Medicine , Lakeland Regional Health , Lakeland , FL , USA
| | - Tim Regan
- a Department of Emergency Medicine , Lakeland Regional Health , Lakeland , FL , USA
| | - Maureen Leckie
- a Department of Emergency Medicine , Lakeland Regional Health , Lakeland , FL , USA
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31
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Buyantseva LV, Brooks J, Rossi M, Lehman E, Craig TJ. Risk factors associated with 30-day asthma readmissions. J Asthma 2016; 53:684-90. [PMID: 27031680 DOI: 10.3109/02770903.2016.1140773] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Assess factors that increase the odds of 30-day asthma readmissions to hospitals. METHODS Retrospective chart review between 1/1/2002 to 12/31/2012 of pediatric and adult patients with the primary diagnosis of asthma readmitted within 30 days after the index admission was performed. Patients were identified from billing database for asthma ICD 9 code (493.9). Inclusion criteria were: physician confirmed asthma diagnosis, one or more asthma admissions and accessible medical records. RESULTS A total of 95 patients with multiple asthma readmissions were included in the final analysis. Thirty-seven patients (39%) were readmitted for asthma within 30 days and 58 patients (61%) had readmission in a 30-365-day period. Demographic characteristics were not significantly different between groups. Bivariate analysis showed that factors associated with higher likelihood of readmissions were a higher frequency of previous admissions, ED visits, inpatient hospitalizations, ICU stays, intubations, chest X-rays, history of chronic sinusitis, gastroesophageal reflux disease, anxiety, and the use of tiotropium or a long-acting beta-agonist (LABA). Multivariable analysis confirmed that prior hospital admissions and a history of GERD are the strongest predictive factors for early asthma readmissions, yet a history of environmental allergies might be a protective factor (p = 0.053). CONCLUSIONS Non-allergic asthma patients with multiple prior admissions, ED visits and inpatient hospitalizations, on multiple medications with history of GERD, sinusitis, and anxiety are more likely to be readmitted within 30 days irrespective of other factors. Patients with these characteristics should be assessed for interventions in an effort to reduce early readmissions.
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Affiliation(s)
- Larisa V Buyantseva
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
| | - Joel Brooks
- b Heart of Lancaster Regional Medical Center , Lititz , PA , USA
| | - Melissa Rossi
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
| | - Erik Lehman
- c Division of Biostatistics in the Department of Public Health Sciences , Penn State University , Hershey , PA , USA
| | - Timothy J Craig
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
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Age-Related Differences in the Rate, Timing, and Diagnosis of 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbation. Chest 2016; 149:1021-9. [PMID: 26836926 DOI: 10.1016/j.chest.2015.12.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission. OBJECTIVES To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences. METHODS Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission. RESULTS Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P < .001). The higher rate attenuated with adjustment (OR, 1.19 [95% CI, 1.13-1.26]; P < .001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with nonrespiratory diagnoses (41.7% vs 53.8%; P < .001). CONCLUSIONS After asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses.
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Lin CS, Chang CC, Yeh CC, Chung CL, Chen TL, Liao CC. Postoperative Adverse Outcomes in Patients With Asthma: A Nationwide Population-based Cohort Study. Medicine (Baltimore) 2016; 95:e2548. [PMID: 26817903 PMCID: PMC4998277 DOI: 10.1097/md.0000000000002548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Outcome after surgery in patients with asthma remains unknown. The purpose of this study is to investigate postoperative major complications and mortality in surgical patients with asthma.Using reimbursement claims from the Taiwan National Health Insurance Research Database, the authors identified 24,109 surgical patients with preoperative asthma and 24,109 nonasthma patients undergoing major surgeries using matching procedure with propensity score by sociodemographics, coexisting medical conditions, and surgical characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day postoperative complications and mortality associated with asthma were analyzed in the multivariate logistic regressions.Asthma increased postoperative pneumonia (OR 1.48; 95% CI 1.34-1.64), septicemia (OR 1.11; 95% CI 1.02-1.21), and urinary tract infection (OR 1.17; 95% CI 1.09-1.26). Preoperative emergency care for asthma was significantly associated with postoperative 30-day in-hospital mortality, with an OR of 1.84 (95% CI 1.11-3.04). Preoperative emergency service, hospitalizations, admission to intensive care unit, and systemic use of corticosteroids for asthma were also associated with higher postoperative complication rates for asthmatic patients.Postoperative complications and mortality were significantly increased in asthmatic patients. We suggest urgent efforts to revise protocols for asthma patients' perioperative care.
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Affiliation(s)
- Chao-Shun Lin
- From the Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan (CSL, CCC, TLC, CCL); Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan (CSL, CCC, TLC, CCL); Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CSL, CCC, TLC, CCL); Department of Surgery, China Medical University Hospital, Taichung, Taiwan (CCY); Department of Surgery, University of Illinois, Chicago, USA (CCY); Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan (CLC); School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan (CCL)
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Wallace SS, Keller SL, Falco CN, Nead JA, Minard CG, Nag PK, Quinonez RA. An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service. Hosp Pediatr 2015; 5:566-73. [PMID: 26526802 DOI: 10.1542/hpeds.2015-0015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the characteristics and reasons for pediatric hospital medicine readmissions. We also aimed to describe characteristics of potentially preventable cases and the reliability of classification. METHODS Retrospective descriptive study from December 2008 through June 2010 in a large academic tertiary care children's hospital in Houston, Texas. Children were included if they were readmitted to the hospital within 30 days of discharge from the pediatric hospital medicine service. Reasons for readmission were grouped into three categories: physician-related, caretaker-related, and disease-related. Readmissions with physician- or caretaker-related reasons were considered potentially preventable. RESULTS The overall readmission rate was 3.1%, and a total of 204 subjects were included in the analysis. Lymphadenitis and failure to thrive had the highest readmission rates with 21%, and 13%, respectively. Twenty percent (n=41/204) of readmissions were preventable with 24% (n=10/41) being physician-related, 12% (n=5/41) caregiver-related, and 63% (n=26/41) for mixed reasons. When comparing classification of readmissions into preventable status, there was moderate agreement between 2 reviewers (K=0.44, 95% confidence interval: 0.28-0.60). Among patients with preventable readmission, the probability of having had a readmission by 7 days and 15 days was 73% and 78%, respectively. CONCLUSIONS Reliable identification of preventable pediatric readmissions using individual reviewers remains a challenge. Additional studies are needed to develop a reliable approach to identify preventable readmissions and underlying modifiable factors. A focused review of 7-day readmissions and diagnoses with high readmission rates may allow use of fewer resources.
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Affiliation(s)
- Sowdhamini S Wallace
- Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas;
| | - Stacey L Keller
- Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Children's Hospital of San Antonio, San Antonio, Texas; and
| | - Carla N Falco
- Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas
| | - Jennifer A Nead
- Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Pratip K Nag
- Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas
| | - Ricardo A Quinonez
- Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Children's Hospital of San Antonio, San Antonio, Texas; and
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Teach SJ, Gergen PJ, Szefler SJ, Mitchell HE, Calatroni A, Wildfire J, Bloomberg GR, Kercsmar CM, Liu AH, Makhija MM, Matsui E, Morgan W, O'Connor G, Busse WW. Seasonal risk factors for asthma exacerbations among inner-city children. J Allergy Clin Immunol 2015; 135:1465-73.e5. [PMID: 25794658 DOI: 10.1016/j.jaci.2014.12.1942] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Asthma exacerbations remain common, even in children and adolescents, despite optimal medical management. Identification of host risk factors for exacerbations is incomplete, particularly for seasonal episodes. OBJECTIVE We sought to define host risk factors for asthma exacerbations unique to their season of occurrence. METHODS This is a retrospective analysis of patients aged 6 to 20 years who comprised the control groups of the Asthma Control Evaluation study and the Inner City Anti-IgE Therapy for Asthma study. Univariate and multivariate models were constructed to determine whether patients' demographic and historical factors, allergic sensitization, fraction of exhaled nitric oxide values, spirometric measurements, asthma control, and treatment requirements were associated with seasonal exacerbations. RESULTS The analysis included 400 patients (54.5% male; 59.0% African American; median age, 13 years). Exacerbations occurred in 37.5% of participants over the periods of observation and were most common in the fall (28.8% of participants). In univariate analysis impaired pulmonary function was significantly associated with greater odds of exacerbations for all seasons, as was an exacerbation in the previous season for all seasons except spring. In multivariate analysis exacerbation in the previous season was the strongest predictor in fall and winter, whereas a higher requirement for inhaled corticosteroids was the strongest predictor in spring and summer. The multivariate models had the best predictive power for fall exacerbations (30.5% variance attributed). CONCLUSIONS Among a large cohort of inner-city children with asthma, patients' risk factors for exacerbation vary by season. Thus information on individual patients might be beneficial in strategies to prevent these seasonal events.
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Affiliation(s)
- Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Aurora, Colo
| | | | | | | | | | | | - Andrew H Liu
- National Jewish Health, Denver, and Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Melanie M Makhija
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | | | - Wayne Morgan
- University of Arizona College of Medicine, Tucson, Ariz
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Chung HS, Hathaway DK, Lew DB. Risk factors associated with hospital readmission in pediatric asthma. J Pediatr Nurs 2015; 30:364-84. [PMID: 25289769 DOI: 10.1016/j.pedn.2014.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/06/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022]
Abstract
Asthma is a leading cause of hospitalization among children, and about 15-50% of pediatric patients are readmitted after an index admission. The purpose of this integrative review is to explore contemporary scientific findings on the association between pediatric asthma readmission and various demographic, environmental, psychosocial and clinical risk factors. An electronic database search resulted in a sample of 29 studies. African American, public or no insurers, previous admission and complex chronic comorbidity were identified as risk factors associated with pediatric asthma readmission. However, more interdisciplinary and well-designed investigations are warranted to further explicate the spectrum of environmental and psychosocial correlates.
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Affiliation(s)
- Hoi Sing Chung
- Loewenberg School of Nursing, The University of Memphis, Memphis, TN.
| | - Donna K Hathaway
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN
| | - Dukhee B Lew
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN; Allergy and Immunology, LeBonheur Children's Hospital, Memphis, TN
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Auger KA, Simon TD, Cooperberg D, Gay J, Kuo DZ, Saysana M, Stille CJ, Fisher ES, Wallace S, Berry J, Coghlin D, Jhaveri V, Kairys S, Logsdon T, Shaikh U, Srivastava R, Starmer AJ, Wilkins V, Shen MW. Summary of STARNet: Seamless Transitions and (Re)admissions Network. Pediatrics 2015; 135:164-75. [PMID: 25489017 PMCID: PMC4279069 DOI: 10.1542/peds.2014-1887] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine.
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Affiliation(s)
- Katherine A. Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tamara D. Simon
- Division of Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - David Cooperberg
- St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - James Gay
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dennis Z. Kuo
- Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michele Saysana
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. Stille
- General Academic Pediatrics, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, Colorado
| | - Erin Stucky Fisher
- University of California San Diego School of Medicine, San Diego, California
| | - Sowdhamini Wallace
- Section of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Jay Berry
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Daniel Coghlin
- Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vishu Jhaveri
- Blue Cross Blue Shield of Arizona representing Blue Cross Blue Shield Association, Phoenix, Arizona
| | - Steven Kairys
- Jersey Shore Medical Center, Neptune Township, New Jersey
| | - Tina Logsdon
- Children’s Hospital Association, Overland Park, Kansas
| | - Ulfat Shaikh
- University of California Davis Health System, Sacramento, California
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Amy J. Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Victoria Wilkins
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Mark W. Shen
- Dell Medical School, University of Texas Austin, Austin, Texas
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Auger KA, Kahn RS, Davis MM, Simmons JM. Pediatric asthma readmission: asthma knowledge is not enough? J Pediatr 2015; 166:101-8. [PMID: 25241184 DOI: 10.1016/j.jpeds.2014.07.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/14/2014] [Accepted: 07/24/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize factors associated with readmission for acute asthma exacerbation, particularly around caregiver asthma knowledge, beliefs, and reported adherence to prescribed medication regimens. STUDY DESIGN We enrolled 601 children (aged 1-16 years) who had been hospitalized for asthma. Caregivers completed a face-to-face survey regarding their asthma knowledge, beliefs, and medication adherence. Caregivers also reported demographic data, child's asthma severity, exposure to triggers, access to primary care, and financial strains. We prospectively identified asthma readmission events via billing data over a 1-year minimum follow-up period. We examined time to readmission with Cox proportional hazards. RESULTS The study cohort's median age was 5 years, 53% were African American, and 57% were covered by Medicaid. At 1 year, 22% had been readmitted for asthma. In the multivariate analysis, a caregiver's demonstration of increased asthma knowledge was associated with increased readmission risk. In addition, children whose caregivers reported less-than-perfect adherence to daily medication regimens had increased readmission risk. Likewise, having previously been admitted for asthma, decreased medical home access, and black race were associated with increased readmission risk. CONCLUSION In a multifactorial assessment of risk factors for asthma readmission, greater asthma knowledge and decreased medication adherence were associated with readmission. Inpatient efforts to prevent readmission might best target medication adherence rather than continuing to primarily provide asthma education.
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Affiliation(s)
- Katherine A Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Robert S Kahn
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Matthew M Davis
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Gerald R Ford School of Public Policy, University of Michigan, Ann Arbor, MI
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Shaw MR, Oneal G. Living on the edge of asthma: A grounded theory exploration. J SPEC PEDIATR NURS 2014; 19:296-307. [PMID: 24888671 DOI: 10.1111/jspn.12080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/12/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Most asthma-related emergency department (ED) visits and hospitalizations for asthma are preventable. Our purpose was to develop a grounded theory to guide interventions to reduce unnecessary hospitalizations and ED visits. DESIGN AND METHODS Grounded theory inquiry guided interviews of 20 participants, including 13 parents and 7 children. RESULTS Living on the edge of asthma was the emergent theory. Categories included: balancing, losing control, seeking control, and transforming. PRACTICE IMPLICATIONS The theory provides the means for nurses to understand the dynamic process that families undergo in trying to prevent and then deal with and learn from an acute asthma attack requiring hospitalization or an ED visit.
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Affiliation(s)
- Michele R Shaw
- College of Nursing, Washington State University, Spokane, Washington, USA
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Vicendese D, Abramson MJ, Dharmage SC, Tang ML, Allen KJ, Erbas B. Trends in asthma readmissions among children and adolescents over time by age, gender and season. J Asthma 2014; 51:1055-60. [PMID: 24949811 DOI: 10.3109/02770903.2014.936447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Little is known about asthma readmissions within 28 days over time by age or gender. We explored trends in childhood asthma hospital readmission rates over time by age, gender and season. METHODS Using a large database of 53,156 childhood admissions with a primary diagnosis of asthma from the Department of Health Victoria Australia for 1997-2009, we explored asthma hospital readmissions rates by seasonality, gender and age (2-18 years) using chi square tests, logistic regression models and graphical techniques. RESULTS Approximately 9459 (28%) of the children had two or more admissions over the whole study period, contributing to 55% (29,056/53,156) of all admissions. Approximately 5% of admissions were repeat admission within 28 days. Over time, despite a decline in asthma incidence, the rate of readmission within 28 days increased, particularly in the 2-12 year age groups. Girls were at greater risk of readmission within 28 days (odds ratio [OR] = 1.15; 95% CI: 1.004-1.32; p = 0.04) and 12 months (OR = 1.11; 95% CI: 1.05-1.19; p = 0.001). Grass pollen season was associated with readmissions within 28 days, but only in boys (p = 0.01). CONCLUSION Over time, despite a fall in asthma incidence, readmission rates for childhood asthma significantly increased in younger age groups with girls at a higher risk of being readmitted than boys. Increased risk of repeat admission for boys was observed during the grass pollen season. These findings highlight high-risk groups, which has implications for both clinical services and patient care. More detailed monitoring of readmission rates amongst various risk groups over time is required.
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Affiliation(s)
- Don Vicendese
- School of Public Health, La Trobe University , Bundoora , Australia
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Bergert L, Patel SJ, Kimata C, Zhang G, Matthews WJ. Linking patient-centered medical home and asthma measures reduces hospital readmission rates. Pediatrics 2014; 134:e249-56. [PMID: 24936001 DOI: 10.1542/peds.2013-1406] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to achieve 100% compliance with all 3 Children's Asthma Care (CAC; CAC-1, CAC-2, CAC-3) measures and track attendance at follow-up appointments with the patient-centered medical home. The impact of these measures on readmission and emergency department utilization rates was evaluated. METHODS This quality improvement study evaluated compliance with CAC measures in pediatric patients aged 2 to 18 years old hospitalized with a primary diagnosis of asthma from January 1, 2008, through June 30, 2012. A multidisciplinary Asthma Task Force was assembled to develop interventions. Attendance at the follow-up appointment was tracked monthly from January 1, 2009. Readmission and emergency department utilization rates were compared between the preimplementation period (January 1, 2006, through December 31, 2007) and the postimplementation period (January 1, 2008, through June 30, 2012). RESULTS The preimplementation period included 231 subjects and the postimplementation period included 532 subjects. Compliance with CAC-3 was 95% from October 1, 2009, through June 30, 2012. Compliance with the postdischarge follow-up appointment was 69% from January 1, 2009 through September 30, 2009, increasing significantly to 90% from October 1, 2009, through June 30, 2012 (P < .001). Postimplementation readmission rates significantly decreased in the 91- to 180-day postdischarge interval (odds ratio: 0.29; 95% confidence interval: 0.11-0.78). CONCLUSIONS In children hospitalized with asthma, compliance with the asthma core measures and the postdischarge follow-up appointment with the primary care provider was associated with reduced readmission rates at 91 to 180 days after discharge. We attribute our results to a comprehensive set of interventions designed by our multidisciplinary Asthma Task Force.
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Affiliation(s)
- Lora Bergert
- Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and
| | - Shilpa J Patel
- Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and
| | | | - Guangxiang Zhang
- Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Wallace J Matthews
- Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and
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Tan CC, McDowell KM, Fenchel M, Szczesniak R, Kercsmar CM. Spirometry use in children hospitalized with asthma. Pediatr Pulmonol 2014; 49:451-7. [PMID: 24000189 DOI: 10.1002/ppul.22854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 05/10/2013] [Indexed: 11/07/2022]
Abstract
Asthma is the most common chronic disorder of childhood and continues to be a leading cause of pediatric hospital admission. The National Asthma Education and Prevention Program (NAEPP) recommends that spirometry be obtained for asthma patients upon hospital admission, after bronchodilation during the acute phase of asthma symptoms, and at least one additional time before discharge from the hospital. The objectives of this study were to describe the use of spirometry in children hospitalized with asthma and to determine association of pulmonary function with future exacerbations. A retrospective cohort study design was utilized involving review of medical records of children ≥5 years old admitted with asthma to Cincinnati Children's Hospital Medical Center from September 1, 2009 to March 31, 2011. Hospitalization or emergency department (ED) visits were identified by the ICD-9-CM codes of having either a primary diagnosis of asthma (493) or a respiratory illness (460-496) plus a secondary diagnosis of asthma. Asthma re-exacerbation was defined as either having an ED visit or hospitalization for asthma that occurred within 3 months after the index hospitalization. All spirometries were performed in a pediatric pulmonary function laboratory. Among 1,037 admissions included in this study, 89 (8.6%) had spirometry that was recommended by a consulting asthma specialist and usually performed on the day of discharge. Spirometries for forty-five of these patients (54.9%) met all acceptability and repeatability criteria of the American Thoracic Society. Patients who performed acceptable spirometry were significantly older (12.4 ± 3.8 vs. 10.7 ± 3.0 years; P = 0.041). The average forced expiratory volume in the first second (FEV1 ) was 84.4 ± 19.7% predicted; forced vital capacity (FVC) was 98.1 ± 16.0% predicted; FEV1 /FVC was 74.6 ± 9.6%; forced expiratory flow at 25-75% (FEF25-75 ) was 61.2 ± 30.1% predicted. Ten patients (22%) who performed spirometry developed a re-exacerbation. Patients with versus without re-exacerbation had significantly lower FEV1 /FVC (P = 0.027) and FEF25-75 (P = 0.031). Nevertheless, separate logistic regression models found that FEV1 /FVC and FEF25-75 were not associated with re-exacerbation when adjusted for age and length-of-stay. We found that few children admitted with asthma had spirometry as recommended in the NAEPP guidelines unless recommended by specialists and both lower lung function (FEV1 /FVC and FEF25-75 ) and history of more frequent and more recent prior health-care utilization for asthma were associated with repeat asthma exacerbation. However, the value of performing spirometry on asthmatic children prior to hospital discharge remains unclear and will require prospective study.
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Affiliation(s)
- Chee Chun Tan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Holland DE, Conlon PM, Rohlik GM, Gillard KL, Tomlinson AL, Raadt DM, Finseth OR, Rhudy LM. Developing and testing a discharge planning decision support tool for hospitalized pediatric patients. J SPEC PEDIATR NURS 2014; 19:149-61. [PMID: 24502681 DOI: 10.1111/jspn.12064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/03/2014] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To develop and test a decision support tool that identifies patients who would benefit from early consult with discharge planners. DESIGN AND METHODS A predictive, correlational design was used with parents/guardians of children (1 month to 18 years; N = 197). Data were collected by interviews and record reviews. Expert consensus determined referral to discharge planning. RESULTS Mean age was 8.7 years; mean length of stay was 7.5 days. Forty percent (n = 79) were identified for early referral. The variable "substantial post-acute care needs" had the strongest association with expert consensus (internally validated AUC = 0.79). PRACTICE IMPLICATIONS Findings from this study provide preliminary evidence for a decision support tool to improve the discharge planning process by reducing individual decision-making variability through systematic matching of patient needs to service delivery.
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Beck AF, Huang B, Simmons JM, Moncrief T, Sauers HS, Chen C, Ryan PH, Newman NC, Kahn RS. Role of financial and social hardships in asthma racial disparities. Pediatrics 2014; 133:431-9. [PMID: 24488745 PMCID: PMC3934338 DOI: 10.1542/peds.2013-2437] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. RESULTS The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
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Affiliation(s)
- Andrew F. Beck
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Hadley S. Sauers
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Chen Chen
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick H. Ryan
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Rehospitalization for childhood asthma: timing, variation, and opportunities for intervention. J Pediatr 2014; 164:300-5. [PMID: 24238863 DOI: 10.1016/j.jpeds.2013.10.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/04/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the timing of pediatric asthma rehospitalization, variation in rate of rehospitalization across hospitals, and factors associated with rehospitalization at different intervals. STUDY DESIGN Retrospective cohort analysis of 44,204 hospitalizations for children with asthma within 42 children's hospitals between July 2008 and June 2011. The main outcome measures were rehospitalization for asthma within 7, 15, 30, 60, 180, and 365 days of an index asthma admission. RESULTS The rate of asthma rehospitalization ranged from 0.5% (n = 208) at 7 days to 17.2% (n = 7603) at 365 days. Black patients and patients with public insurance had higher odds of rehospitalization at 60 days and beyond (P ≤ .01 for both). Adolescents (12- to 18-year-old), patients with a diagnosis of a complex chronic condition, and patients with a prior year asthma admission had higher odds of rehospitalization at every time interval (P ≤ .001 for all). Significant hospital variation in case-mix adjusted rates of rehospitalization existed at each time interval (P ≤ .01 for all). Rates at 365 days were ≤ 10.9% for the top 10% of hospitals; if all hospitals achieved this rate, 36.6% of rehospitalizations might have been avoided. CONCLUSIONS Significant variation in asthma rehospitalization rates exists across children's hospitals from 7 to 365 days after an index admission. Racial/ethnic and economic disparities emerge at 60 days. By 1 year, rehospitalizations account for 1 in 6 hospitalizations. Assessing asthma rehospitalizations at longer intervals may augment our current understanding of and approach to post-hospitalization care improvement.
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AlJuburi G, Laverty AA, Green SA, Phekoo KJ, Bell D, Majeed A. Socio-economic deprivation and risk of emergency readmission and inpatient mortality in people with sickle cell disease in England: observational study. J Public Health (Oxf) 2013; 35:510-7. [DOI: 10.1093/pubmed/fdt100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
PURPOSE OF REVIEW Asthma outcomes constitute the cornerstone of asthma clinical research. Despite their known importance, it has been difficult for researchers to standardize these outcomes in large part because of the heterogeneity of the disease. This review seeks to provide an overview of recent recommendations for standardization of asthma outcomes in clinical trials, as well as discuss areas of future interest. RECENT FINDINGS Several outcome measures have been recommended and are used in evaluating different interventions in asthma clinical trials. Such outcomes include lung function, asthma control measures, symptoms, exacerbations, quality of life, biomarkers, healthcare utilization and cost of care. More recently, recommendations for core measures, supplemental measures and future areas of interest for all future asthma clinical trials have been recommended by the Asthma Outcomes Workshop supported by the National Institute of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ) in the US. SUMMARY Standardization of asthma outcomes allows the comparison of results across multiple studies and centers. The recommendations of the Asthma Outcomes Workshop constitute an excellent first step in standardizing the way in which asthma outcomes are assessed. The asthma research community is now charged with implementing these recommendations and expanding upon them.
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Tubbs-Cooley HL, Cimiotti JP, Silber JH, Sloane DM, Aiken LH. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf 2013; 22:735-42. [PMID: 23657609 PMCID: PMC3756461 DOI: 10.1136/bmjqs-2012-001610] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Hospital patient-to-nurse staffing ratios are associated with quality outcomes in adult patient populations but little is known about how these factors affect paediatric care. We examined the relationship between staffing ratios and all-cause readmission (within 14 days, 15–30 days) among children admitted for common medical and surgical conditions. Methods We conducted an observational cross-sectional study of readmissions of children in 225 hospitals by linking nurse surveys, inpatient discharge data and information from the American Hospital Association Annual Survey. Registered Nurses (N=14 194) providing direct patient care in study hospitals (N=225) and children hospitalised for common conditions (N=90 459) were included. Results Each one patient increase in a hospital's average paediatric staffing ratio increased a medical child's odds of readmission within 15–30 days by a factor of 1.11, or by 11% (95% CI 1.02 to 1.20) and a surgical child's likelihood of readmission within 15–30 days by a factor of 1.48, or by 48% (95% CI 1.27 to 1.73). Children treated in hospitals with paediatric staffing ratios of 1 : 4 or less were significantly less likely to be readmitted within 15–30 days. There were no significant effects of nurse staffing ratios on readmissions within 14 days. Discussion Children with common conditions treated in hospitals in which nurses care for fewer patients each are significantly less likely to experience readmission between 15 and 30 days after discharge. Lower patient-to-nurse ratios hold promise for preventing unnecessary hospital readmissions for children through more effective predischarge monitoring of patient conditions, improved discharge preparation and enhanced quality improvement success.
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Shaw MR, Daratha KB, Odom-Maryon T, Bindler RC. Pediatric patients with asthma: a high-risk population for subsequent hospitalization. J Asthma 2013; 50:548-54. [PMID: 23544368 DOI: 10.3109/02770903.2013.790414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Asthma is one of the most common chronic conditions among children and is one of the leading causes for pediatric hospitalizations. More evidence is needed to clarify the risks of repeat hospitalization and the underlying factors contributing to adverse health outcomes among pediatric patients hospitalized with asthma. The purpose of this study was to examine the risk of subsequent hospitalizations among pediatric patients hospitalized with asthma compared to a reference cohort of children hospitalized for all other diagnoses. METHODS The Washington State (WA) Comprehensive Hospital Abstract Reporting System (CHARS) was used to obtain data for the study. Data describing 81,946 hospitalized pediatric patients admitted from 2004 to 2008 were available. The risk of subsequent hospitalization among children admitted for asthma as compared to a reference cohort was examined. RESULTS The asthma cohort had a 33% (HR = 1.33 [99% confidence interval (CI) 1.21-1.46]; p < .001) increased risk of subsequent hospitalization from 2004 to 2008. Children in the asthma cohort under the age of 13 years demonstrated a significant increased risk of subsequent hospitalization as compared to the age-matched reference cohort of children without asthma. Those in the asthma cohort who were 3-5 years old demonstrated the highest risk (50%) of subsequent hospitalization (HR = 1.50 [99% CI 1.23-1.83]; p < .001). CONCLUSIONS Study results can be utilized in the development of appropriate interventions aimed at preventing and reducing hospital admissions, improving patient care, decreasing overall costs, and lessening complications among pediatric patients with asthma.
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Affiliation(s)
- Michele R Shaw
- College of Nursing, Washington State University, Spokane, WA 99210-1495, USA
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Vicendese D, Olenko A, Dharmage S, Tang M, Abramson M, Erbas B. Modelling and predicting low count child asthma hospital readmissions using General Additive Models. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojepi.2013.33019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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