Does participation in the community outreach for asthma care and healthy lifestyles (COACH) program alter subsequent use of hospital services for children discharged with asthma?

Abstract

Introduction: Transition from hospital to home is a challenging time for children with asthma and their caregivers because of the high risk for reutilization of acute hospital services. Detecting effective quality improvement initiatives to reduce utilization of urgent services in children discharged with asthma is an important clinical and public health question. This study was designed to identify the role of a multimodal, nurse-driven, inpatient initiated Community Outreach for Asthma Care and Healthy lifestyles (COACH) program on subsequent use of hospital services for pediatric patients with asthma.

Methods: We utilized comparative effectiveness design to identify the difference in recurrent emergency department (ED) visits and/or admissions within 12-months after discharge between patients with asthma who engaged in the COACH program (Intervention group) and those who did not (Comparison group). We used administrative databases of hospitals included in the Meridian Health system to identify the number of and time to asthma-related readmissions and ED re-attendances.

Results: We found no difference in the rate or number of recurrent hospital-based services used within 12 months, but found a reduction in ED re-visitation and/or readmission within 30 days for COACH program participants prior to and after adjustment for age, race/ethnicity, insurance status, and clinical presentation (Odd Ratio 0.44, 95% Confidence Interval 0.20, 0.93).

Conclusion: Participation in the COACH program decreases the likelihood for subsequent use of hospital services within a month of discharge for children with asthma. Enhanced post-discharge interactions with families may reduce long-term reuse of hospital-based services for COACH program participants.

Keywords:

• Hospitalization
• pediatric
• healthcare expenditure
• quality improvement
• healthcare utilization
• comparative effectiveness

Acknowledgements

We would like to acknowledge Barbara Birde Cirella, MS, CPNP, AE-C, COACH program manager and Marie Gonzalez, RN, COACH nursing educator for their tireless work and dedication to improving care for children with asthma, as well as our patients whose medical records were utilized to complete this study.

Declaration of interest

The funding for the COACH program was provided by a Centers for Medicare and Medicaid Service (CMS) grant managed by the New Jersey Department of Health. Drs. Pinto, Navallo and Petrova have no financial disclosure or conflict of interest relevant to this article to disclose.

Figure 4. Frequency (%) of ED revisits, readmissions, and combined data on ED and/or hospitalizations after discharge for study participants