Asthma exacerbations in North American adults : Who are the frequent fliers in the emergency department?
To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. The 3,151 enrolled patients were classified into four groups:...
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Veröffentlicht in: | Chest 2005-05, Vol.127 (5), p.1579-1586 |
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creator | GRISWOLD, Sharon K NORDSTROM, Carla R CLARK, Sunday GAETA, Theodore J PRICE, Michelle L CAMARGO, Carlos A |
description | To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year.
Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later.
The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year.
High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs. |
doi_str_mv | 10.1378/chest.127.5.1579 |
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Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later.
The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year.
High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.127.5.1579</identifier><identifier>PMID: 15888831</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: American College of Chest Physicians</publisher><subject>Adult ; Asthma ; Asthma - epidemiology ; Asthmatics ; Biological and medical sciences ; Cardiology. Vascular system ; Care and treatment ; Chronic obstructive pulmonary disease, asthma ; Collaboration ; Confidence intervals ; Costs ; Demographic aspects ; Emergency medical care ; Emergency service ; Emergency Service, Hospital - utilization ; Expenditures ; Female ; Frequent flier programs ; Hospitals ; Humans ; Logistic Models ; Male ; Medicaid ; Medical referrals ; Medical sciences ; Patients ; Pneumology ; Primary care ; Quality of life ; Social Class ; United States - epidemiology</subject><ispartof>Chest, 2005-05, Vol.127 (5), p.1579-1586</ispartof><rights>2005 INIST-CNRS</rights><rights>COPYRIGHT 2005 Elsevier B.V.</rights><rights>Copyright American College of Chest Physicians May 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16752143$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15888831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>GRISWOLD, Sharon K</creatorcontrib><creatorcontrib>NORDSTROM, Carla R</creatorcontrib><creatorcontrib>CLARK, Sunday</creatorcontrib><creatorcontrib>GAETA, Theodore J</creatorcontrib><creatorcontrib>PRICE, Michelle L</creatorcontrib><creatorcontrib>CAMARGO, Carlos A</creatorcontrib><title>Asthma exacerbations in North American adults : Who are the frequent fliers in the emergency department?</title><title>Chest</title><addtitle>Chest</addtitle><description>To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year.
Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later.
The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year.
High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.</description><subject>Adult</subject><subject>Asthma</subject><subject>Asthma - epidemiology</subject><subject>Asthmatics</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Care and treatment</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Collaboration</subject><subject>Confidence intervals</subject><subject>Costs</subject><subject>Demographic aspects</subject><subject>Emergency medical care</subject><subject>Emergency service</subject><subject>Emergency Service, Hospital - utilization</subject><subject>Expenditures</subject><subject>Female</subject><subject>Frequent flier programs</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medical referrals</subject><subject>Medical sciences</subject><subject>Patients</subject><subject>Pneumology</subject><subject>Primary care</subject><subject>Quality of life</subject><subject>Social Class</subject><subject>United States - epidemiology</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpt0ctrFTEUB-Agir2t7l1JEOxuxjzn4aZcii8oulFcDieZkzspM5lrkgH73xvtFUGaLEIO3zn8Qgh5wVnNZdu9sROmXHPR1rrmuu0fkR3vJa-kVvIx2THGRSWbXpyR85RuWbnzvnlKzrjuypJ8R6Z9ytMCFH-CxWgg-zUk6gP9vMY80f2C0VsIFMZtzom-pd-nlUJEmiekLuKPDUOmbvYY_7T9LmNpOmCwd3TEI8S8FHL1jDxxMCd8fjovyLf3775ef6xuvnz4dL2_qQ5SyVy1zhlnOArFWtY31kpwYJkxfSNH0Rs0yiLX0oBCZE514HgHTBghjBsB5AW5vJ97jGsJl_Kw-GRxniHguqWhaTshVKsLfPUfvF23GEq2QTCmGq2ZLKi6RweYcfDBrTmCLY_DCPMa0PlS3nMpWtVwroqvH_Blj7h4-2DDy1OKzSw4DsfoF4h3w98fKuD1CUCyMLsIwfr0zzWtFmWO_AVro6Da</recordid><startdate>20050501</startdate><enddate>20050501</enddate><creator>GRISWOLD, Sharon K</creator><creator>NORDSTROM, Carla R</creator><creator>CLARK, Sunday</creator><creator>GAETA, Theodore J</creator><creator>PRICE, Michelle L</creator><creator>CAMARGO, Carlos A</creator><general>American College of Chest Physicians</general><general>Elsevier B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20050501</creationdate><title>Asthma exacerbations in North American adults : Who are the frequent fliers in the emergency department?</title><author>GRISWOLD, Sharon K ; NORDSTROM, Carla R ; CLARK, Sunday ; GAETA, Theodore J ; PRICE, Michelle L ; CAMARGO, Carlos A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g343t-7ffbfb1e2407096cc3afac0bb963d29beb4ce153ba4ee0f48af18a02b22bfdaa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Asthma</topic><topic>Asthma - epidemiology</topic><topic>Asthmatics</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Care and treatment</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Collaboration</topic><topic>Confidence intervals</topic><topic>Costs</topic><topic>Demographic aspects</topic><topic>Emergency medical care</topic><topic>Emergency service</topic><topic>Emergency Service, Hospital - utilization</topic><topic>Expenditures</topic><topic>Female</topic><topic>Frequent flier programs</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicaid</topic><topic>Medical referrals</topic><topic>Medical sciences</topic><topic>Patients</topic><topic>Pneumology</topic><topic>Primary care</topic><topic>Quality of life</topic><topic>Social Class</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>GRISWOLD, Sharon K</creatorcontrib><creatorcontrib>NORDSTROM, Carla R</creatorcontrib><creatorcontrib>CLARK, Sunday</creatorcontrib><creatorcontrib>GAETA, Theodore J</creatorcontrib><creatorcontrib>PRICE, Michelle L</creatorcontrib><creatorcontrib>CAMARGO, Carlos A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>GRISWOLD, Sharon K</au><au>NORDSTROM, Carla R</au><au>CLARK, Sunday</au><au>GAETA, Theodore J</au><au>PRICE, Michelle L</au><au>CAMARGO, Carlos A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Asthma exacerbations in North American adults : Who are the frequent fliers in the emergency department?</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>2005-05-01</date><risdate>2005</risdate><volume>127</volume><issue>5</issue><spage>1579</spage><epage>1586</epage><pages>1579-1586</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year.
Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later.
The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year.
High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.</abstract><cop>Northbrook, IL</cop><pub>American College of Chest Physicians</pub><pmid>15888831</pmid><doi>10.1378/chest.127.5.1579</doi><tpages>8</tpages></addata></record> |
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subjects | Adult Asthma Asthma - epidemiology Asthmatics Biological and medical sciences Cardiology. Vascular system Care and treatment Chronic obstructive pulmonary disease, asthma Collaboration Confidence intervals Costs Demographic aspects Emergency medical care Emergency service Emergency Service, Hospital - utilization Expenditures Female Frequent flier programs Hospitals Humans Logistic Models Male Medicaid Medical referrals Medical sciences Patients Pneumology Primary care Quality of life Social Class United States - epidemiology |
title | Asthma exacerbations in North American adults : Who are the frequent fliers in the emergency department? |
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