Discharge strategies to prevent asthma readmissions

February 9, 2018, Children's National Medical Center
Kavita Parikh, M.D., M.S.H.S., an associate professor of pediatrics at Children's National Health System and lead study author. Credit: Children's National Health System

Readmission rates at three months for kids hospitalized for acute asthma dropped when families received comprehensive education prior to discharge, the only single component of discharge bundles that was strongly associated with lowered readmissions, finds a multicenter retrospective cohort study published online Feb. 1, 2018, in The Journal of Pediatrics.

According to the Centers for Disease Control and Prevention, asthma is the most common chronic lung disease of childhood, affecting roughly 6 million U.S. children. Hospitalization for asthma accounts for $1.5 billion in annual charges and represents almost one-third of childhood asthma costs.

Children who are hospitalized for asthma have a roughly 20 percent chance of returning to the hospital in the next year, and individual hospital rates can range from 5.7 percent to 9.1 percent at three months, writes the study team. While the National Institutes of Health (NIH) has published evidence-based guidelines for discharge planning, there is no single, standardized asthma discharge process used across all pediatric hospitals in the U.S. that impacts 30-day readmission rates.

"Improving how we care for children who are hospitalized with asthma includes preparing them for a successful return home with the best tools to manage their illness and prevent a future hospital visit," says Kavita Parikh, M.D., M.S.H.S., an associate professor of pediatrics at Children's National Health System and lead study author. "Our study underscores the importance of increasing the intensity of select discharge components. For example, ensuring that children hospitalized for asthma receive at discharge along with comprehensive education and environmental mitigation may reduce asthma readmissions."

The study team analyzed records from a national sample of tertiary care children's hospitals, looking at hospitalizations of 5- to 17-year-olds for exacerbation during the 2015 calendar year. They characterized how frequently hospitals used 13 separate asthma discharge components by distributing an electronic survey to quality leaders. Forty-five of 49 hospitals (92 percent) completed the survey.

The 45 hospitals recorded a median of 349 asthma discharges per year and had a median adjusted readmission rate of 2.6 percent at 30 days and a 6.6 percent median adjusted readmission rate at three months. The most commonly used discharge components employed for children with asthma were having a dedicated person providing education (76 percent), providing a spacer at discharge (67 percent) and communicating with a primary medical doctor (58 percent).

Discharge components that were trending toward reduced at three months include:

  • Comprehensive asthma education, including having dedicated asthma educators
  • Medications and devices provided to patients at discharge, such as spacers, beta-agonists, controller medication and oral steroids
  • Communication and scheduled appointments with a primary medical doctor
  • Post-discharge activities, including home visits and referrals for environmental mitigation programs.

"In addition to being aligned with NIH recommendations, connecting the family with a primary care provider and oral steroids at discharge helps to improve patients' timely access to care if symptoms recur when they return home," Dr. Parikh adds. "Bundling these components may offer multiple opportunities to educate patients and families and to employ a range of communication styles such as didactic, visual and interactive."

Explore further: Racial, ethnic disparities in pediatric readmission rates for chronic disease vary by condition

More information: Kavita Parikh et al, Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma, The Journal of Pediatrics (2018). DOI: 10.1016/j.jpeds.2017.11.062

Related Stories

Racial, ethnic disparities in pediatric readmission rates for chronic disease vary by condition

April 25, 2017
Disparities in pediatric readmission rates for chronic conditions such as asthma, depression, diabetes, migraines, and seizures vary, with the lowest one-year readmissions recorded for depression and the highest one-year ...

Compliance with child asthma care measures cuts readmission

June 16, 2014
(HealthDay)—For children hospitalized with asthma, compliance with care measures is associated with a reduction in readmission rates, according to a study published online June 16 in Pediatrics.

Asthma attacks on the decline among U.S. kids

February 6, 2018
(HealthDay)—Fewer U.S. children are having to deal with asthma attacks in recent years, federal health officials reported Tuesday.

Obesity may exacerbate asthma in children

October 18, 2017
In a Pediatric Allergy & Immunology study of children hospitalized for asthma, obesity was a risk factor for repeated hospital admissions.

Eczema plus family history can mean a longer hospital stay for kids with asthma

October 27, 2017
Asthma and allergies are related, and many people who suffer from asthma have allergies that trigger their asthma. Research being presented at the American College of Allergy, Asthma and Immunology's (ACAAI) Annual Scientific ...

Weekend discharge not linked to increased readmission

July 12, 2015
(HealthDay)—For patients with acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia, weekend discharge is not associated with 30-day readmission, according to a study published online June 30 ...

Recommended for you

Researchers identify source of molecule linked to nasal polyps, asthma attacks

May 23, 2018
A new discovery about how the immune system responds to common sinus infections and asthma could explain why patients develop these issues in the first place and ultimately may lead to improved targeted therapies. Researchers ...

App helps hearing-impaired parents know when and why their baby is crying

May 23, 2018
For parents Delbert and Sanaz Whetter a crying baby is a particularly difficult challenge. The Whetters are deaf, so when they're in another room they rely on cameras and remote noise-monitors to help keep an eye on their ...

Study demonstrates new treatment for severe asthma

May 22, 2018
Researchers from McMaster University and the Firestone Institute for Respiratory Health at St. Joseph's Healthcare Hamilton, together with colleagues at other partnering institutions, have developed a new method to treat ...

Pregnancy drug DES might have triggered ADHD in the grandchildren of women who used it

May 21, 2018
A study conducted by researchers at Columbia University's Mailman School of Public Health and Harvard T.H. Chan School of Public Health reported elevated odds for attention deficit hyperactivity disorder (ADHD) in the grandchildren ...

Eczema drug effective against severe asthma

May 21, 2018
Two new studies of patients with difficult-to-control asthma show that the eczema drug dupilumab alleviates asthma symptoms and improves patients' ability to breathe better than standard therapies. Dupilumab, an injectable ...

Age-related racial disparity in suicide rates among US youth

May 21, 2018
New research suggests the suicide rate is roughly two times higher for black children ages 5-12 compared with white children of the same age group. The study, funded by the National Institute of Mental Health (NIMH), appears ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.