A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department? Academic Article Article uri icon

Overview

MeSH

  • Acute Disease
  • Adolescent
  • Adult
  • Ambulatory Care
  • Anti-Asthmatic Agents
  • Chi-Square Distribution
  • Female
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Referral and Consultation
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States
  • Young Adult

MeSH Major

  • Asthma
  • Emergency Service, Hospital
  • Health Resources

abstract

  • Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these major gaps in asthma care. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

authors

publication date

  • November 2014
  • December 2014

has subject area

  • Acute Disease
  • Adolescent
  • Adult
  • Ambulatory Care
  • Anti-Asthmatic Agents
  • Asthma
  • Chi-Square Distribution
  • Emergency Service, Hospital
  • Female
  • Guideline Adherence
  • Health Care Surveys
  • Health Resources
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Referral and Consultation
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States
  • Young Adult

Research

keywords

  • Journal Article
  • Multicenter Study
  • Observational Study

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1016/j.jaip.2014.06.012

PubMed ID

  • 25439365

Additional Document Info

start page

  • 733

end page

  • 740

volume

  • 2

number

  • 6