Using Billing Data to Describe Patterns in Asthma-Related Emergency Department Visits in Children

Abstract

OBJECTIVES. To describe the development and evaluation of a pilot emergency department (ED)-based asthma surveillance system for childhood asthma visits based on billing data and to illustrate how the data can be used to document trends and patterns in ED visits for asthma in children.METHODS. During 2001 and 2002, aggregate reports based on ED billing data from 3 hospitals in western Michigan were obtained from a single physician billing company. Data were tabulated and graphed to show trends in the monthly number of ED visits for asthma in children. Comparisons were made by age, gender, and site. We evaluated the system by using established guidelines.RESULTS. The data illustrated strong seasonal trends, as well as marked differences in ED use according to age and gender. The total numbers of asthma ED visits were remarkably similar between the 2 years evaluated; however, the timing and duration of the seasonal peaks differed. Our evaluation of the system found that it met many of the characteristics that define successful surveillance systems, including simplicity, flexibility, acceptability, sensitivity and positive predictive value, timeliness, and stability. However, the surveillance system's representativeness was limited by the inability to calculate valid population-based ED-visit rates. Despite this limitation, the data provided useful information by documenting the burden and demographic profile of children who use the ED for asthma care and in identifying seasonal and time-related trends.CONCLUSIONS. We were able to successfully implement a pilot ED-based surveillance system for childhood asthma visits by using billing data. This system promotes the understanding of the burden of asthma among children visiting the ED. The development of an ED-based surveillance system for childhood asthma visits using billing data is recommended, particularly when there is a desire to understand the characteristics of children with asthma who use the ED and/or a need to understand the impact of local asthma quality-improvement programs. A STHMA IS ONE of the most common reasons for presentation to emergency departments (EDs), and this chronic disease places a heavy but potentially preventable burden on the US health care system. 1-3 Children Յ14 years of age make ϳ600 000 ED visits for asthma every year in the United States, and the number of ED visits increased by 14% during the 1990s. 1 Between 10% and 30% of ED visits for asthma are repeat visits, and frequent ED use is associated with greater asthma severity and/or poor management, as well as poverty, ethnicity, and urban residence. [4][5][6][7] The current high level of interest concerning asthma stems from several features including the increase in asthma prevalence and mortality observed over recent decades, 8,9 the large costs involved, 10 the disproportionate effect on minority populations, 11 the concern about possible environmental causes, and the belief that the application of current clinical guidelines should result in better asthma control. 12 ...

Winter Temperature Inversions and Emergency Department Visits for Asthma in Salt Lake County, Utah, 2003–2008

“…Silverman et al (2003), after conducting a 2-week review of ED patient charts and billing data in 11 New York City hospitals, reported 75% of asthma diagnoses listed in patient charts were also coded as asthma in the billing data. Reeves et al (2006) reported similarly high concordance between asthma diagnoses listed in pediatric ED patient charts and billing data. Because we implemented a case-crossover design, each case served as his or her own control and confounding by between-person differences and covariates that do not change within individuals during the study period (sex, race) was eliminated (Carracedo-Martínez et al 2010).…”

“…The ED billing data used in this study are likely to reflect valid diagnoses of asthma (Reeves et al 2006; Silverman et al 2003). Silverman et al (2003), after conducting a 2-week review of ED patient charts and billing data in 11 New York City hospitals, reported 75% of asthma diagnoses listed in patient charts were also coded as asthma in the billing data.…”

“…Asthmatics may have self-medicated more often or remained mostly indoors during inversions. Despite the high concordance of asthma diagnoses between billing data and ED patient charts (Reeves et al 2006; Silverman et al 2003), ED visits for asthma may have been misclassified, particularly on inversion days if clinicians knew of the association between air pollution and asthma and of the association between inversions and air pollution. Thus, effect measure estimates could have been biased toward or away from the null.…”

Disparities in Asthma Hospitalizations among Children Seen in the Emergency Department

“…This dataset could be used to further investigate the effects of multiple encounters, health insurance, and seasonality on pediatric asthma. Asthma surveillance systems should also be expanded to include survey and environmental data to provide a more comprehensive picture of asthma (18,24,25). This study demonstrates how existing datasets can be integrated to enhance the surveillance of pediatric asthma and provide greater insight into the burden of asthma.…”

“…Although hospitalization and ED records are available, few states have integrated the two datasets (18). The integration of ED and hospitalization record improves the surveillance of asthma by de-duplicating the records and assigning multiple records to unique individuals to accurately calculate rates (19).…”