Glenn Flores, MD¹, Milagros Abreu, MD², Sandra C. Tomany, MS¹, and John R. Meurer, MD, MBA³. (1) Center for the Advancement of Urban Children, Medical College of Wisconsin/Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, (2) Medical College of Wisconsin, Center for the Advancement of Urban Children, 8701 Watertown Plank Road, Milwaukee, WI 53226, 414-456-8273, milagros.abreu@bmc.org, (3) Pediatrics (Community Care), Medical College of Wisconsin, 8701 Watertown Plank Road, MFRC CAUC, Milwaukee, WI 53226-0509

Background: 214,000 hospitalizations occur each year among the 6.3 million US children who have asthma. Not enough is known about how to prevent pediatric asthma hospitalizations. Objectives: To identify the proportion of preventable pediatric asthma hospitalizations and how such hospitalizations might be prevented, according to parents and physicians of hospitalized asthmatic children. Methods: Cross-sectional survey of parents, primary care pediatricians (PCPs), and inpatient attending physicians (IAPs) of a consecutive series of all children admitted for asthma to an urban hospital in a 14-month period. Results: The 235 hospitalized children had a mean age of 4 years; most were poor (mean annual family income = $14,795), non-white (91%), and had public (74%) or no (14%) health insurance. Compared with children hospitalized for other ambulatory-sensitive conditions, hospitalized asthmatic children were significantly more likely to be African-American (70% vs. 57%), older, and to not have made a physician visit or phone contact prior to admission (52% vs. 41%). Only 26% of parents said that their child's admission was avoidable, compared with 36% of PCPs and 43% of IAPs. The proportion of asthma hospitalizations assessed as preventable varied according to the source or combination of sources, from 17% for agreement among all three sources to 52% as identified by any one of the 3 sources. PCPs (81%) and IAPs (71%) significantly more often (P < .001) than parents (39%) cited parent/patient-related reasons for how hospitalizations could have been avoided, including adhering to and refilling medications, better outpatient follow-up, and avoiding known disease triggers. Parents (28%) and IAPs (28%) significantly more often (P < .008) than PCPs (10%) cited physician-related reasons for how hospitalizations could have been avoided, including better education by physicians about the child's condition, and better quality of care. Multivariate analyses revealed that an age ³ 11 years, finding medical care to be too expensive, no physician contact prior to the hospitalization, working poor family income, and having no health insurance were associated with approximately 2-9 times the odds of a preventable asthma hospitalization. Conclusions: The proportion of asthma hospitalizations assessed as preventable varies from 17-52%, depending on the source. Adolescents, families who find care to be too expensive, families who fail to contact physicians prior to hospitalization, children from working-poor families, and uninsured children are at greatest risk for preventable hospitalizations. Many pediatric asthma hospitalizations might be prevented if parents and children were better educated about the child’s condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers.

Learning Objectives:

• At the conclusion of the session, the participant will be able to identify the proportion of preventable pediatric asthma hospitalizations and how such hospitalizations might be prevented, according to parents and physicians of hospitalized asthmatic children.

Keywords: Asthma, Children With Special Needs

Presenting author's disclosure statement:
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.