Common denominators of children repeatedly hospitalized for asthma

Preventable hospital readmissions often indicate less than ideal care during a hospital stay and after discharge. Because of this, efforts to improve quality of care and reduce health care expenditures have focused on preventing readmission through better coordination of post-discharge care services with patients and their families. One area where such efforts are needed is childhood asthma.

New research by Juha Baek, DrPH, MPSA, a recent graduate of the Texas A&M University School of Public Health who is currently working as a postdoctoral fellow at the Center for Outcomes Research at the Houston Methodist Research Institute, and colleagues from the Texas A&M School of Public Health, the Houston Methodist Research Institute and Driscoll Children’s Hospital in Corpus Christi, Texas, studied the characteristics of pediatric patients with repeated asthma-related hospitalizations at a children’s hospital in South Texas. The study, published in the Journal of Asthma, uses data on asthma-related hospitalizations from 2010 to 2016 together with environmental and socioeconomic factors of the neighborhoods in which patients live. The intent is to identify common characteristics of patients with frequent hospitalizations to inform efforts to improve care.

The researchers used records on more than 900 patients between the ages of 5 and 18 who were admitted to Driscoll Children’s Hospital at least once for asthma. They collected data on admission and discharge dates, neighborhood as indicated by census tract and demographic data such as age, gender and ethnicity. These data were combined with information on particulate matter and ground-level ozone for each census tract as well as a social vulnerability index score based on 15 factors, including income, education level, employment, types of housing and prevalence of single-parent households. They also measured the interval between hospitalizations. For their analysis, Baek and colleagues divided patients into three groups: a low hospitalization group with one hospitalization (no readmission), a medium group with two to three hospitalizations (one or two readmissions) and a high group with four or more hospitalizations (three or more readmissions).

The research team found that around 13 percent of the patients in the study had two or three hospitalizations and 2.4 percent had four or more. This high-use group, although small, accounted for an outsized measure of hospital use and patients stayed in the hospital significantly longer than low-use or medium-use patients. They also noted that the high-use patients had much shorter intervals between hospital visits. For individual factors, the researchers found that younger children, those who stayed in the hospital longer at the initial admission, and those who had their first hospitalization in warmer months were more likely to have higher numbers of hospitalizations. They also observed greater readmissions for children living in neighborhoods with high ground-level ozone.

These findings show that some patients are at a greater risk of readmission than others. However, the researchers note a few limitations that could be addressed in future research. The study used data from a single hospital in South Texas and relied on estimated levels of only two ambient air pollutants. The data also did not include factors such as tobacco exposure, asthma severity or other health conditions. The researchers note that future studies should cover more hospitals and geographic regions, include other individual and environmental factors and categorize patients by the amount of time between admissions.

This study adds to the understanding of asthma-related hospital readmissions and sheds light on which patients are most likely to have preventable hospital readmissions. Additionally, because most of the readmissions occurred more than 90 days after the initial hospitalization, monitoring of patients beyond 30 days would likely be beneficial. By better targeting these patients with longer-term monitoring and transitional care like asthma education, hospitals could significantly reduce preventable readmissions, improving care quality and reducing health care costs.