A Multicenter Observational Study of US Adults with Acute Asthma: Who Are the Frequent Users of the Emergency Department?

Kohei Hasegawa, Ashley F. Sullivan, Eva Tovar Hirashima, Theodore J. Gaeta, Christopher Fee, Stuart J. Turner, Susan Massaro, Carlos A. Camargo, Kirk A. Stiffler, Stewart O. Sanford, Hannah Todorowski, Howard A. Smithline, Michael G. Gonzalez, Nathan Shapiro, Daniel J. Pallin, Mark J. Leber, Jeanne M. Basior, D. Matthew Sullivan, John T. Powell, Brigitte M. BaumannClaire Pearson, John E. Gough, Michael J. Drescher, Richard O. Gray, Richard M. Nowak, Rashid F. Kysia, Muhammad Waseem, Robert A. Silverman, Frank LoVecchio, Eva Tovar Hirashima, Patrick Shen, Rita K. Cydulka, Mark Clark, Sunday Clark, Eric J. Wasserman, Annette O. Arthur, Stephanie Nonas, Joseph S. Myslinski, Francis L. Counselman, J. Adrian Tyndall, Blanca Grand, Nancy E. Wang, Megan Healy, Bernard L. Lopez, P. Charles Inboriboon, Talmage M. Holmes, Suzanne S. Teuber, Mark I. Langdorf, Brian Snyder, Rose M. Chasm, Cameron Crandall, Dan Mosely, Ava E. Pierce, Ronald S. Benenson

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.

Original languageEnglish (US)
Pages (from-to)733-740.e3
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume2
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Multicenter Studies
Observational Studies
Hospital Emergency Service
Asthma
Insurance
Patient Acceptance of Health Care
Population
Adrenal Cortex Hormones
Guidelines
Morbidity

Keywords

  • Acute asthma
  • Emergency department
  • Epidemiology exacerbation
  • Health care utilization
  • Racial disparity
  • Socioeconomic status

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

A Multicenter Observational Study of US Adults with Acute Asthma : Who Are the Frequent Users of the Emergency Department? / Hasegawa, Kohei; Sullivan, Ashley F.; Tovar Hirashima, Eva; Gaeta, Theodore J.; Fee, Christopher; Turner, Stuart J.; Massaro, Susan; Camargo, Carlos A.; Stiffler, Kirk A.; Sanford, Stewart O.; Todorowski, Hannah; Smithline, Howard A.; Gonzalez, Michael G.; Shapiro, Nathan; Pallin, Daniel J.; Leber, Mark J.; Basior, Jeanne M.; Sullivan, D. Matthew; Powell, John T.; Baumann, Brigitte M.; Pearson, Claire; Gough, John E.; Drescher, Michael J.; Gray, Richard O.; Nowak, Richard M.; Kysia, Rashid F.; Waseem, Muhammad; Silverman, Robert A.; LoVecchio, Frank; Hirashima, Eva Tovar; Shen, Patrick; Cydulka, Rita K.; Clark, Mark; Clark, Sunday; Wasserman, Eric J.; Arthur, Annette O.; Nonas, Stephanie; Myslinski, Joseph S.; Counselman, Francis L.; Tyndall, J. Adrian; Grand, Blanca; Wang, Nancy E.; Healy, Megan; Lopez, Bernard L.; Inboriboon, P. Charles; Holmes, Talmage M.; Teuber, Suzanne S.; Langdorf, Mark I.; Snyder, Brian; Chasm, Rose M.; Crandall, Cameron; Mosely, Dan; Pierce, Ava E.; Benenson, Ronald S.

In: Journal of Allergy and Clinical Immunology: In Practice, Vol. 2, No. 6, 2014, p. 733-740.e3.

Research output: Contribution to journalArticle

Hasegawa, K, Sullivan, AF, Tovar Hirashima, E, Gaeta, TJ, Fee, C, Turner, SJ, Massaro, S, Camargo, CA, Stiffler, KA, Sanford, SO, Todorowski, H, Smithline, HA, Gonzalez, MG, Shapiro, N, Pallin, DJ, Leber, MJ, Basior, JM, Sullivan, DM, Powell, JT, Baumann, BM, Pearson, C, Gough, JE, Drescher, MJ, Gray, RO, Nowak, RM, Kysia, RF, Waseem, M, Silverman, RA, LoVecchio, F, Hirashima, ET, Shen, P, Cydulka, RK, Clark, M, Clark, S, Wasserman, EJ, Arthur, AO, Nonas, S, Myslinski, JS, Counselman, FL, Tyndall, JA, Grand, B, Wang, NE, Healy, M, Lopez, BL, Inboriboon, PC, Holmes, TM, Teuber, SS, Langdorf, MI, Snyder, B, Chasm, RM, Crandall, C, Mosely, D, Pierce, AE & Benenson, RS 2014, 'A Multicenter Observational Study of US Adults with Acute Asthma: Who Are the Frequent Users of the Emergency Department?', Journal of Allergy and Clinical Immunology: In Practice, vol. 2, no. 6, pp. 733-740.e3. https://doi.org/10.1016/j.jaip.2014.06.012
Hasegawa, Kohei ; Sullivan, Ashley F. ; Tovar Hirashima, Eva ; Gaeta, Theodore J. ; Fee, Christopher ; Turner, Stuart J. ; Massaro, Susan ; Camargo, Carlos A. ; Stiffler, Kirk A. ; Sanford, Stewart O. ; Todorowski, Hannah ; Smithline, Howard A. ; Gonzalez, Michael G. ; Shapiro, Nathan ; Pallin, Daniel J. ; Leber, Mark J. ; Basior, Jeanne M. ; Sullivan, D. Matthew ; Powell, John T. ; Baumann, Brigitte M. ; Pearson, Claire ; Gough, John E. ; Drescher, Michael J. ; Gray, Richard O. ; Nowak, Richard M. ; Kysia, Rashid F. ; Waseem, Muhammad ; Silverman, Robert A. ; LoVecchio, Frank ; Hirashima, Eva Tovar ; Shen, Patrick ; Cydulka, Rita K. ; Clark, Mark ; Clark, Sunday ; Wasserman, Eric J. ; Arthur, Annette O. ; Nonas, Stephanie ; Myslinski, Joseph S. ; Counselman, Francis L. ; Tyndall, J. Adrian ; Grand, Blanca ; Wang, Nancy E. ; Healy, Megan ; Lopez, Bernard L. ; Inboriboon, P. Charles ; Holmes, Talmage M. ; Teuber, Suzanne S. ; Langdorf, Mark I. ; Snyder, Brian ; Chasm, Rose M. ; Crandall, Cameron ; Mosely, Dan ; Pierce, Ava E. ; Benenson, Ronald S. / A Multicenter Observational Study of US Adults with Acute Asthma : Who Are the Frequent Users of the Emergency Department?. In: Journal of Allergy and Clinical Immunology: In Practice. 2014 ; Vol. 2, No. 6. pp. 733-740.e3.
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title = "A Multicenter Observational Study of US Adults with Acute Asthma: Who Are the Frequent Users of the Emergency Department?",
abstract = "Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46{\%}) had 1 or more (frequent) ED visits in the past year. Specifically, 28{\%} had 1 to 2 visits, 11{\%} had 3 to 5 visits, and 7{\%} had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85{\%} lacked evidence of prior evaluation by an asthma specialist, and 43{\%} were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.",
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author = "Kohei Hasegawa and Sullivan, {Ashley F.} and {Tovar Hirashima}, Eva and Gaeta, {Theodore J.} and Christopher Fee and Turner, {Stuart J.} and Susan Massaro and Camargo, {Carlos A.} and Stiffler, {Kirk A.} and Sanford, {Stewart O.} and Hannah Todorowski and Smithline, {Howard A.} and Gonzalez, {Michael G.} and Nathan Shapiro and Pallin, {Daniel J.} and Leber, {Mark J.} and Basior, {Jeanne M.} and Sullivan, {D. Matthew} and Powell, {John T.} and Baumann, {Brigitte M.} and Claire Pearson and Gough, {John E.} and Drescher, {Michael J.} and Gray, {Richard O.} and Nowak, {Richard M.} and Kysia, {Rashid F.} and Muhammad Waseem and Silverman, {Robert A.} and Frank LoVecchio and Hirashima, {Eva Tovar} and Patrick Shen and Cydulka, {Rita K.} and Mark Clark and Sunday Clark and Wasserman, {Eric J.} and Arthur, {Annette O.} and Stephanie Nonas and Myslinski, {Joseph S.} and Counselman, {Francis L.} and Tyndall, {J. Adrian} and Blanca Grand and Wang, {Nancy E.} and Megan Healy and Lopez, {Bernard L.} and Inboriboon, {P. Charles} and Holmes, {Talmage M.} and Teuber, {Suzanne S.} and Langdorf, {Mark I.} and Brian Snyder and Chasm, {Rose M.} and Cameron Crandall and Dan Mosely and Pierce, {Ava E.} and Benenson, {Ronald S.}",
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TY - JOUR

T1 - A Multicenter Observational Study of US Adults with Acute Asthma

T2 - Who Are the Frequent Users of the Emergency Department?

AU - Hasegawa, Kohei

AU - Sullivan, Ashley F.

AU - Tovar Hirashima, Eva

AU - Gaeta, Theodore J.

AU - Fee, Christopher

AU - Turner, Stuart J.

AU - Massaro, Susan

AU - Camargo, Carlos A.

AU - Stiffler, Kirk A.

AU - Sanford, Stewart O.

AU - Todorowski, Hannah

AU - Smithline, Howard A.

AU - Gonzalez, Michael G.

AU - Shapiro, Nathan

AU - Pallin, Daniel J.

AU - Leber, Mark J.

AU - Basior, Jeanne M.

AU - Sullivan, D. Matthew

AU - Powell, John T.

AU - Baumann, Brigitte M.

AU - Pearson, Claire

AU - Gough, John E.

AU - Drescher, Michael J.

AU - Gray, Richard O.

AU - Nowak, Richard M.

AU - Kysia, Rashid F.

AU - Waseem, Muhammad

AU - Silverman, Robert A.

AU - LoVecchio, Frank

AU - Hirashima, Eva Tovar

AU - Shen, Patrick

AU - Cydulka, Rita K.

AU - Clark, Mark

AU - Clark, Sunday

AU - Wasserman, Eric J.

AU - Arthur, Annette O.

AU - Nonas, Stephanie

AU - Myslinski, Joseph S.

AU - Counselman, Francis L.

AU - Tyndall, J. Adrian

AU - Grand, Blanca

AU - Wang, Nancy E.

AU - Healy, Megan

AU - Lopez, Bernard L.

AU - Inboriboon, P. Charles

AU - Holmes, Talmage M.

AU - Teuber, Suzanne S.

AU - Langdorf, Mark I.

AU - Snyder, Brian

AU - Chasm, Rose M.

AU - Crandall, Cameron

AU - Mosely, Dan

AU - Pierce, Ava E.

AU - Benenson, Ronald S.

PY - 2014

Y1 - 2014

N2 - Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.

AB - Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.

KW - Acute asthma

KW - Emergency department

KW - Epidemiology exacerbation

KW - Health care utilization

KW - Racial disparity

KW - Socioeconomic status

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