Variation in hospital diagnostic practices may affect patterns of asthma morbidity when these data are used for surveillance. Using data from New York City Public Hospitals we assess variation in asthma diagnosis and explore whether decreasing asthma morbidity can be ascribed to changing diagnostic practices or if hospital specific practice patterns account for local variation in asthma morbidity. Methods: Emergency Department (ED) administrative data for lower respiratory diagnoses (LRD) (International Classification of Diseases -9th Revision (ICD-9) codes 466, 490-518) for New York City public hospitals for 1995-1999 were analyzed by age group, race, and hospital. Age specific time trends in ED visits for asthma versus other LRD were assessed. The proportion of asthma versus other LRD was assessed across facilities by age group and race. Results: As much as 23% of the decrease in ED visits for asthma among infants may be attributed to an increase in bronchiolitis diagnoses. Among adults 40+, 45% of the decrease could be attributed to a shift to COPD/Bronchitis diagnosis. Minor changes were observed for other age groups. Across facilities, there were significant differences in the proportion of LRD coded as asthma in infants and older adults. Conclusions: Temporal changes in asthma morbidity may reflect changing diagnostic patterns. Across facilities, differences in the proportion of ED visits for lower respiratory diagnoses coded as asthma may reflect hospital specific practice patterns rather than true differences in asthma morbidity. Both these observations were more common in infants and older adults.
Learning Objectives: 1)describe some determinants of variation in asthma diagnoses in an urban multihospital environment 2)Evaluate how variation in diagnosis may impact asthma surveillance
Keywords: Asthma, Surveillance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.