Pediatric asthma hospitalizations among urban minority children and the continuity of primary care.

TitlePediatric asthma hospitalizations among urban minority children and the continuity of primary care.
Publication TypeJournal Article
Year of Publication2017
AuthorsUtidjian LH, Fiks AG, A Localio R, Song L, Ramos MJ, Keren R, Bell LM, Grundmeier RW
JournalJ Asthma
Pagination1-8
Date Published2017 Feb 25
ISSN1532-4303
Abstract

OBJECTIVE: To examine the effect of ambulatory health care processes on asthma hospitalizations.

METHODS: A retrospective cohort study using electronic health records was completed. Patients aged 2-18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives. Occurrence of one or more asthma hospitalizations was the primary outcome of interest. We used a log linear model (Poisson regression) to model the association between the factors of interest and number of asthma hospitalizations.

RESULTS: 5,712 children with asthma were available for analysis. 96% of the children were African American. The overall hospitalization rate was 64 per 1,000 children per year. None of the commonly used asthma-specific indicators of high quality care were associated with fewer asthma hospitalizations. Children with documented asthma who experienced a lack of primary health care (no more than one outpatient visit at their primary care location in the 2 years preceding hospitalization) were at higher risk of hospitalization compared to those children with a greater number of visits (incidence rate ratio 1.39; 95% CI 1.09-1.78).

CONCLUSIONS: In children with asthma, more frequent primary care visits are associated with reduced asthma hospitalizations.

DOI10.1080/02770903.2017.1294695
Alternate JournalJ Asthma
PubMed ID28332939