TY - JOUR
T1 - A Multicenter Observational Study of US Adults with Acute Asthma
T2 - Who Are the Frequent Users of the Emergency Department?
AU - Multicenter Airway Research Collaboratione- 36 Investigators
AU - Hasegawa, Kohei
AU - Sullivan, Ashley F.
AU - Tovar Hirashima, Eva
AU - Gaeta, Theodore J.
AU - Fee, Christopher
AU - Turner, Stuart J.
AU - Massaro, Susan
AU - Camargo, Carlos A.
AU - Stiffler, Kirk A.
AU - Sanford, Stewart O.
AU - Todorowski, Hannah
AU - Smithline, Howard A.
AU - Gonzalez, Michael G.
AU - Shapiro, Nathan
AU - Pallin, Daniel J.
AU - Leber, Mark J.
AU - Basior, Jeanne M.
AU - Sullivan, D. Matthew
AU - Powell, John T.
AU - Baumann, Brigitte M.
AU - Pearson, Claire
AU - Gough, John E.
AU - Drescher, Michael J.
AU - Gray, Richard O.
AU - Nowak, Richard M.
AU - Kysia, Rashid F.
AU - Waseem, Muhammad
AU - Silverman, Robert A.
AU - LoVecchio, Frank
AU - Hirashima, Eva Tovar
AU - Shen, Patrick
AU - Cydulka, Rita K.
AU - Clark, Mark
AU - Clark, Sunday
AU - Wasserman, Eric J.
AU - Arthur, Annette O.
AU - Nonas, Stephanie
AU - Myslinski, Joseph S.
AU - Counselman, Francis L.
AU - Tyndall, J. Adrian
AU - Grand, Blanca
AU - Wang, Nancy E.
AU - Healy, Megan
AU - Lopez, Bernard L.
AU - Inboriboon, P. Charles
AU - Holmes, Talmage M.
AU - Teuber, Suzanne S.
AU - Langdorf, Mark I.
AU - Snyder, Brian
AU - Chasm, Rose M.
N1 - Publisher Copyright:
© 2014 American Academy of Allergy, Asthma & Immunology.
PY - 2014
Y1 - 2014
N2 - Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.
AB - Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.
KW - Acute asthma
KW - Emergency department
KW - Epidemiology exacerbation
KW - Health care utilization
KW - Racial disparity
KW - Socioeconomic status
UR - https://www.scopus.com/pages/publications/84923218176
U2 - 10.1016/j.jaip.2014.06.012
DO - 10.1016/j.jaip.2014.06.012
M3 - Article
C2 - 25439365
AN - SCOPUS:84923218176
SN - 2213-2198
VL - 2
SP - 733-740.e3
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 6
ER -