Home Care Plans Not Lowering ER Visits

Kids with asthma still returning despite instructions

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Hospital emergency departments have improved how they treat kids with severe asthma attacks, but sending young patients home with a plan to treat their asthma does not seem to help prevent readmission.

The Children's Asthma Care process evaluates whether patients ages 2 to 17 admitted to the hospital with an asthma exacerbation received the appropriate treatment as well as a home treatment plan when discharged. Hospitals seem to doing a stellar job treating the kids with the appropriate drugs, but they appear to have little impact on helping the children care for themselves.

"An asthma home care plan is no guarantee against readmission."

Rustin B. Morse, M.D., of the University of Arizona College of Medicine and Phoenix Children's Hospital, along with his colleagues looked at three different measures of compliance with Children's Asthma Care (CAC): whether the patients received asthma relievers (criterion 1) and systemic corticosteroids (criterion 2) during their time in the ER and whether they were given a complete home management plan of care (criterion 3) when discharged. The study's authors then looked at how compliance was related with improvements in patient outcomes.

The study included administrative and CAC compliance data from 30 children's hospitals in the U.S., so its authors looked at the records for nearly 37,300 children admitted with asthma between January 2008 and September 2010, accounting for almost 45,500 hospital admissions. Follow-up was through December 2010.

Compliance, the study found, with criteria 1 and 2 was high, with the minimum quarterly compliance rates reported by a hospital coming in at 97% and about 90%, respectively. For criterion 3, though, the findings were not initially so good. The average compliance for it was about 41% during the first three quarters of the study but improved to almost 73% during the last three quarters of the study.

While one might think a patient discharged with an at-home asthma care plan would be less likely to be readmitted for another severe asthma attack, the researchers discovered that the relationship between patients receiving a care plan and patients keeping their asthma controlled was not quite so strong. They write, "We did not find a statistically significant association between aggregate [criterion 3] compliance and postdischarge [emergency room] utilization or asthma-related readmission rates at 7, 30 or 90 days." They found that on average, about 2% of these patients returned to the ER at 7 days, 4% returned at 30 days and 11% at 90 days.

These findings, the researchers note, suggest that within children's hospitals, the CAC criteria alone are not an appropriate way to evaluate and compare the quality of care provided to children admitted with asthma attacks.

The study appears in the October 5 issue of the Journal of the American Medical Association.

Reviewed by: 
Review Date: 
October 4, 2011
Last Updated:
October 5, 2011