Rehospitalization of children with asthma

Background: Although some children with asthma experience multiple admissio ns, asthma is considered a preventable cause of hospitalization. Objective: To assess whether components of medical histories, ambulatory ca re prior to hospitalization, or ambulatory care after discharge are associa ted with repeated hospitalizations for children admitted with asthma. Design: Nested case-control study of a cohort of children hospitalized for asthma, comparing those who were rehospitalized within 1 year with those no t rehospitalized. Setting: Urban pediatric primary care clinic. Participants and Methods: Subjects were 119 children, aged 0 to 14 years, w ho had an inpatient admission with a diagnosis of asthma between July 1, 19 93, and June 30, 1995 (index hospitalization). Data sources included medica l charts, computerized patient records, and administrative data. Use of hea lth care services was compared among children who were rehospitalized withi n 1 year of the index admission and those who were not. Main Outcome Measure: Repeated hospitalizations. Results: The proportions of children who received general pediatric, allerg y, or pulmonary care in the year prior to the index hospitalization were 86 %, 7%, and 8%, respectively. By report, half of all children did not receiv e prescribed therapies, more than half were exposed to cigarette smoke at h ome, and one fourth were not up-to-date with immunizations at the time of a dmission. Thirty-five of the 119 children hospitalized with asthma were sub sequently readmitted with asthma within 1 year of the index hospitalization . Children readmitted did not differ from those with a single admission in terms of the above characteristics. However, significantly more children su bsequently readmitted had a pulmonary consultation during the index admissi on (23% vs 4%; P = .001) or in the year following discharge (37% vs 12%; P = .002). In addition, children readmitted were more likely to have other ch ronic conditions (69%, vs 49%; P = .048). Conclusion: Among low-income urban children, readmission for asthma is not associated with receipt of prescribed therapies or pediatric care.