Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study

Abstract

Objectives

To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use.

Methods

We recruited 767 children aged 3–18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively.

Results

Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3–5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00–2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions.

Conclusions

Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.

Keywords:

• Asthma
• paediatrics
• readmissions
• linkage

Acknowledgements

The authors thank Dr. Shaoke Lei for his assistance with data analysis and Ms Rachel Pelly for her assistance with recruitment and data collection.

Disclosure statement

All authors have completed the Unified Competing Interest form (available on request from the corresponding author).

Data availability statement

The corresponding author, KC, has access to the complete study data, which can be shared on request.

Additional information

Funding

This study is funded by the Melbourne Academic Center for Health, Rapid Applied Research Translation 2.1 Grant. The funding body did not influence the submitted work. The authors have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.