Pediatric Asthma-Related ED Visits: Effect of Follow-Up Care Within 14 Days

In children and adolescents, follow-up within 14 days of an asthma-related emergency department (ED) visit lowers the rate of subsequent asthma-related ED revisits in both the short and long term, according to a study published in Academic Pediatrics.

Although guidelines for the management of asthma recommend that patients be referred for a follow-up visit within 1 to 4 weeks after being treated in the ED for an asthma exacerbation, some prior research has indicated that a follow-up visit may not be beneficial and may actually increase ED use in the following year.

Researchers assessed the association between follow-up after an asthma-related ED visit and the likelihood of subsequent asthma-related ED utilization in patients ages 3 to 21 by examining data from California Medicaid (2014 to 2016), and Vermont (2014 to 2016) and Massachusetts (2013 to 2015) all-payer claims databases. For study purposes, the investigators defined “follow-up” as a visit with a primary care provider or an asthma specialist within 14 days of an ED visit.

Of the 90,267 pediatric ED visits identified, the researchers found that 22.6% of these patients had follow-up within 14 days. These patients tended to be younger and more likely to have health insurance, as well as complex chronic conditions and evidence of previous asthma. Follow-up was associated with decreased subsequent asthma-related ED revisits short-term at 60 days (P <.001) and long-term at 365 days (P <.001), as well as a decreased rate of repeated subsequent ED revisits (P <.001).

The authors concluded, “We found a protective association between outpatient 14-day follow-up and asthma-related ED revisits.” They added, “Our findings highlight an opportunity for improvement, with only 22.6% of those with asthma-related ED visits having 14-day follow-up.”

Among the limitations of this study was its observational design, which researchers said precluded them from attributing causality to the associations they found. “Our findings warrant further research to test interventions to support follow-up and primary care accessibility,” they added.

Reference

Bardach NS, Harder VS, McCulloch CE, et al. Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization. Acad Pediatr. 2022;22(3S):S125-S132. doi: 10.1016/j.acap.2021.10.015