Variables Associated with Emergency Department Utilization by Pediatric Patients with Asthma in a Federally Qualified Health Center

Abstract

To study variables associated with Emergency Department (ED) utilization among pediatric patients with asthma in a Federally Qualified Health Center (FQHC). We analyzed Electronic Health Record (EHR) data in a retrospective cohort study of patients with asthma between ages 2 and 18 who received primary care at a FQHC. The primary outcome studied was a visit to the ED at Ann and Robert Lurie’s Children’s Hospital (LCH) for an acute visit related to asthma. Univariate analyses and a multiple logistic regression were performed to study the effect of demographic and clinical variables on ED utilization. Of the 286 patients in the initial EHR query, 200 were included in the final analysis. The median age of subjects in the study cohort was 8.73 years. Patients in the cohort with ED visits averaged 1.32 ED visits in the 15-month period of analysis. The multivariable logistic regression model demonstrated the significant predictors of ED utilization were (1) younger age (OR 0.977, 0.968–0.984, P < 0.001), (2) proximity of patient residence to the hospital when compared with their primary care medical home (OR 0.907, 95% CI 0.828–0.992, P < 0.05), and (3) absence of an asthma action plan (OR 0.079, 95% CI, 0.016–0.283, P < 0.001). Younger age, closer relative proximity of the patient’s home to the hospital compared with the clinic, and absence of an asthma action plan were all identified as significant predictors of ED utilization. Sex, ethnicity, language, passive smoke exposure, and insurance status were not statistically significant predictors of ED utilization.

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Correspondence to Jesse Shechter.

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Appendix

Appendix

See Tables 1, 2, 3, 4 and 5.

Table 1 Summary of exclusion criteria
Table 2 Summary of controller medications by drug class
Table 3 Results of two tailed T-testing or Chi-square analysis for risk factors between the ED and Non-ED cohort
Table 4 Results of multiple regression with all variables included
Table 5 Results of final Lasso Regression without secondhand smoke exposure and insurance status

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Shechter, J., Roy, A., Naureckas, S. et al. Variables Associated with Emergency Department Utilization by Pediatric Patients with Asthma in a Federally Qualified Health Center. J Community Health 44, 948–953 (2019). https://doi.org/10.1007/s10900-019-00653-6

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Keywords

  • Asthma
  • Emergency Department
  • Action plan