Asthma-related emergency department use: current perspectives

Abstract

Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care. Treatment of patients with asthma should include the acute exacerbation, long-term management of controller medications, and controlling triggers in the home environment. We will address the current state of asthma research in emergency medicine in the US, and discuss some of the resources being used to help provide a medical home and improve care for patients who suffer from acute asthma exacerbations.

Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

“…None of the patients were uninsured. It would also be relevant to note that the existing literature on ED utilization in the insured population has found race and severity to be significant predictors of recurrent ED visits [ 1 , 2 , 3 ]. This study did not find asthma severity and other socioeconomic factors like race and insurance to be significant predictors of “repeat” ED visits, suggesting that future research may be needed to understand key drivers of “repeat” ED visits and unscheduled healthcare use for childhood asthma in a largely insured population with access to primary and specialty care.…”

“…The existing literature has found the biggest determinants of ED utilization for childhood asthma to be access to care, disease severity, and socioeconomic factors. However, the vast majority of these studies have been undertaken among uninsured children and children with insurance coverage gaps [ 1 , 2 , 3 , 12 , 13 , 14 ]. The population of interest to this study is an insured population with access to primary and specialty outpatient care for childhood asthma.…”

“…Asthma is the most common pediatric chronic disease in the US, affecting nearly 10 million children (approximately 15%) under 18 years of age [ 1 , 2 , 3 ]. It is also among the top three leading causes of hospitalizations among children.…”

“…Past studies evaluating recurring visits (within one year) to pediatric EDs have found asthma to be the most common diagnosis within all recurring-visit groups and the most common diagnosis for high-frequency users (four or more recurring visits). In 2010, an evaluation of state Medicaid programs estimated a combined USD 272 million spent on asthma-related ED visits among children [ 1 , 2 ].…”

Combined Effect of Race/Ethnicity and Type of Insurance on Reuse of Urgent Hospital-Based Services in Children Discharged with Asthma

“…It has been shown that Black children are at higher risk for asthma than white children, only among those from families with a low income to federal poverty level ratio [15]. Utilization of hospital-based emergency services for the treatment of asthma, including return to the emergency department (ED) after discharge, is a significant burden to the healthcare system [16] and a negative marker for quality of care [17,18] that can also be associated with patients' social context [19,20]. In the present study, we examine an association of revisitation to the ED by children discharged with asthma with respect to their race/ethnicity combined with type of health insurance coverage.…”