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Cynthia S. Minkovitz, MD, MPP; John S. Andrews, MD; Janet R. Serwint, MD

Arch Pediatr Adolesc Med. 1999;153:727-730.

Background  Although some children with asthma experience multiple admissions, asthma is considered a preventable cause of hospitalization.

Objective  To assess whether components of medical histories, ambulatory care prior to hospitalization, or ambulatory care after discharge are associated with repeated hospitalizations for children admitted with asthma.

Design  Nested case-control study of a cohort of children hospitalized for asthma, comparing those who were rehospitalized within 1 year with those not rehospitalized.

Setting  Urban pediatric primary care clinic.

Participants and Methods  Subjects were 119 children, aged 0 to 14 years, who had an inpatient admission with a diagnosis of asthma between July 1, 1993, and June 30, 1995 (index hospitalization). Data sources included medical charts, computerized patient records, and administrative data. Use of health care services was compared among children who were rehospitalized within 1 year of the index admission and those who were not.

Main Outcome Measure  Repeated hospitalizations.

Results  The proportions of children who received general pediatric, allergy, or pulmonary care in the year prior to the index hospitalization were 86%, 7%, and 8%, respectively. By report, half of all children did not receive prescribed therapies, more than half were exposed to cigarette smoke at home, and one fourth were not up-to-date with immunizations at the time of admission. Thirty-five of the 119 children hospitalized with asthma were subsequently readmitted with asthma within 1 year of the index hospitalization. Children readmitted did not differ from those with a single admission in terms of the above characteristics. However, significantly more children subsequently readmitted had a pulmonary consultation during the index admission (23% vs 4%; P=.001) or in the year following discharge (37% vs 12%; P=.002). In addition, children readmitted were more likely to have other chronic conditions (69% vs 49%; P=.048).

Conclusion  Among low-income urban children, readmission for asthma is not associated with receipt of prescribed therapies or pediatric care.

From the Department of Population and Family Health Sciences, Johns Hopkins University School of Hygiene and Public Health (Dr Minkovitz), and the Department of Pediatrics, Johns Hopkins School of Medicine (Drs Andrews and Serwint), Baltimore, Md.

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