Predictors of outpatient follow-up care after adult emergency department asthma visits and association with 30-day outcomes

Abstract

Objective: Guidelines recommend outpatient follow-up after emergency department visits for asthma, but factors related to rates of follow-up among the adult population are understudied. We sought to describe patient and community-level predictors of outpatient follow-up after an index ED visit for asthma and evaluate the association between outpatient follow-up visits and subsequent ED revisits.Methods: We conducted a retrospective observational cohort study of adult patients with emergency departments visits for asthma. The primary predictor was time to outpatient follow-up visit within 30 days of the index ED visit. The primary outcome was all-cause ED revisit within 30 days of the index ED visit. Cox proportional hazards regression was utilized to test the association between time to outpatient follow-up and hazard of ED revisit within 30 days.Results: Time to outpatient follow-up visit within 30 days was not significantly associated with hazard of 30-day ED revisit for asthma (HR 1.05; 95% CI 0.69–1.61). However, male patients (HR 1.45; 95% C 1.11–1.89) and smokers (HR 1.67; 95% CI 1.22–2.29) were significantly more likely to have an ED revisit.Conclusion: Younger, Black patients with Medicaid were less likely to receive follow-up care relative to older patients insured by Medicare. While follow-up visits were not associated with 30-day revisit rates, differences by age, race, and insurance status suggest disproportionate barriers to accessing care. Future research may target these subgroups to improve transitions of care after an ED visit for asthma.

Keywords:

• Asthma
• outpatient follow-up
• emergency department
• transitions of care

Declarations of interest

The authors report there are no competing interests to declare.

Additional information

Funding

Dr. Abbott was supported by NIH-NHLBI (5T32HL129974-04; PI: Lynne Richardson MD). Dr. Lin was supported by NIH-NHLBI K23 HL143042. This work was supported in part through the computational and data resources and staff expertise provided by Scientific Computing and Data at the Icahn School of Medicine at Mount Sinai.