Pediatric Asthma Readmission: Asthma Knowledge Is Not Enough? - 18/09/14

Doi : 10.1016/j.jpeds.2014.07.046

Katherine A. Auger, MD, MSc ^1,^2,^⁎ , Robert S. Kahn, MD, MPH ^2,³, Matthew M. Davis, MD, MAPP ^4,^5,^6,^7,⁸, Jeffrey M. Simmons, MD, MSc ^1,²
¹ Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
² James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
³ Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
⁴ Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
⁵ Department of Internal Medicine, University of Michigan, Ann Arbor, MI
⁶ Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI
⁷ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
⁸ Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI

^∗Reprint requests: Katherine A. Auger, MD, 3333 Burnet Ave, MLC 9016, Cincinnati, OH 45229.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 18 September 2014

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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Keyword : AHR, ED, HR, ICD-9-CM

Plan

Bivariate Association with Readmission

Multivariable Association with Readmission

Post Hoc Analysis of Asthma Knowledge

Measure Reliability

Discussion

Supported by Thrasher Foundation (New Investigator award, grant NR-0048), Cincinnati Children's Hospital Medical Center (CCHMC; Outcomes Research Award to J.S.), the Bureau of Health Professions (BHPr; to J.S.), Health Resources and Services Administration (HRSA; to J.S.), Department of Health and Human Services (DHHS) (under CCHMC NRSA Primary Care Research Fellowship in Child and Adolescent HealthT32HP10027; to J.S.). K.A. received salary support from the Robert Wood Johnson Foundation (Clinical Scholars Program). The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS, or the US Government. The authors declare no conflicts of interest.