Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center

Abstract

This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider–patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital–community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.

The Untapped Potential of the Quadruple Aim of Primary Care to Foster a Culture of Health

“…Providers that have made efforts to screen for such unmet social needs in turn have been able to design interventions (eg, successfully implementing telehealth in place of clinic visits for childhood asthma outpatient care) to both address unmet social needs and improve health outcomes (eg, reduce the rate of no-shows for well visits, and by extension emergency visits for childhood asthma). 20 Providers have the potential to expand their efforts to address adverse social determinants of health through cross-sector collaborations, eg, through training of asthma providers based in schools and through collaboration with public health housing authorities to improve indoor air quality in patients’ homes. 20 Likewise, they could play a significant role in promoting health equity and access to care in their communities by linking individuals and families at risk of losing Medicaid insurance with enrollment assistance support offered by state departments of social services or health insurance exchanges.…”

“… 20 Providers have the potential to expand their efforts to address adverse social determinants of health through cross-sector collaborations, eg, through training of asthma providers based in schools and through collaboration with public health housing authorities to improve indoor air quality in patients’ homes. 20 Likewise, they could play a significant role in promoting health equity and access to care in their communities by linking individuals and families at risk of losing Medicaid insurance with enrollment assistance support offered by state departments of social services or health insurance exchanges.…”