Patterns and predictors of asthma-related emergency department use in Harlem

Study objectives: To assess the roles of poor access to care, psychological risk factors, and asthma severity in frequent emergency department (ED) us e. Design: A cross-sectional survey. Setting: Harlem Hospital Center ED and outpatient chest clinic. Participants: Three hundred seventy-five adult residents of Harlem, a predo minantly African-American community in New York City. Measurements: Asthma severity was assessed by self-reported symptoms using National Asthma Education and Prevention Program guidelines, health-care ut ilization, and psychometric scales. Results: Respondents with more severe asthma were more likely to have a pri mary asthma care provider, and to have had more scheduled office visits for asthma in the year prior to the interview (mean number of visits for patie nts with severe asthma, 3.6 visits; moderate asthma, 2.4 visits; and mild a sthma, 1.7 visits). Despite having a regular source of care, 69% of respond ents identified the ED as their preferred source of care; 82% visited the E D more than once in the year prior to interview (median, four visits). Pers ons with moderate or severe asthma were 3.8 times more likely to be frequen t ED users compared to those with mild asthma (odds ratio [OR], 3.8; 95% co nfidence interval [CI], 2.2. to 6.6). This was the strongest predictor of f requent ED use. Other predictors of ED use were number of comorbid disorder s (OR, 1.5; 95% CI, 1.1 to 2.1) and self-reported global health in the year prior to the ED visit (OR, 1.8; 95% CI, 1.2 to 2.7). Psychological charact eristics were not predictive of frequent ED use when controlling for diseas e severity. Conclusions: Frequent ED users present with serious medical conditions. The y do not substitute physician care with ED care, they augment it to address serious health needs.