BACKGROUND: In the United States, asthma remains a significant health and economic burden to society. Without proper management, asthma can result in emergency department (ED) visits and hospitalizations. In 2010, there were 1.9 million asthma-related ED visits and 439,000 asthma-related hospitalizations nationwide, representing billions in medical expenses. Although asthma prevalence in the rural TriCounty region of Utah is similar to that of the state of Utah, asthma-related ED visits/hospitalizations rates in TriCounty were about double Utah rates in 2011. The TriCounty Health Department and Utah Department of Health requested CDC assistance to investigate factors that contribute to elevated asthma-related ED visits/hospitalizations in TriCounty.
METHODS: We performed a medical record review for all asthma-related ED visits/hospitalizations (those with ICD-9 codes 493–493.9 as the primary diagnosis) during 2013 in the two largest TriCounty hospitals with EDs. We developed, pilot tested, and revised a standardized medical record data abstraction form and collected demographic and clinical data. We calculated descriptive statistics to characterize the study population and performed a subgroup analysis of patients with a self-reported history of asthma and excluded repeat-visits. We used chi-squared test, Fisher’s exact test, and Wilcoxon-Mann-Whitney test with α=0.05 to compare differences among subgroups.
RESULTS: We identified 251 asthma-related ED visits and 68 hospitalizations, representing 221 unique patients aged <1–99 years, and covering 88% of all asthma-related ED visits/hospitalizations in TriCounty in 2013. Age-adjusted rates of asthma-related ED visits and hospitalizations in TriCounty were 43.9 (vs.16.3 in Utah) and 9.3 (vs. 3.6 in Utah) per 10,000 population for persons aged ≥18 years, respectively. Individuals with ≥2 ED visits accounted for 33% of ED visits. In 82% of ED visits, patients reported taking no long-term control medications (LTCM), and 77% indicated a history of asthma according to medical record. One individual accounted for 9% of all hospitalizations. Fifty-six percent of hospitalizations reported taking no LTCM, and 74% indicated a history of asthma. Among patients with a history of asthma, persons with health insurance were more likely to have a primary care provider than persons without insurance (P<0.002).
CONCLUSIONS: Most asthma-related ED visits/hospitalizations involved patients with a history of asthma, but LTCM use was limited, contrary to recommendations of current guidelines for asthma treatment. Many of the ED visits/hospitalizations involved repeat visits, suggesting poor asthma control. Efforts to increase insurance coverage, access to primary care providers, and guidelines-based treatment among persons with asthma could reduce asthma-related ED visits/hospitalizations.