Original Article
Childhood Asthma Hospital Discharge Medication Fills and Risk of Subsequent Readmission

https://doi.org/10.1016/j.jpeds.2014.12.019Get rights and content

Objective

To assess the relationship between posthospitalization prescription fills for recommended asthma discharge medication classes and subsequent hospital readmission.

Study design

This was a retrospective cohort analysis of Medicaid Analytic Extract files from 12 geographically diverse states from 2005-2007. We linked inpatient hospitalization, outpatient, and prescription claims records for children ages 2-18 years with an index hospitalization for asthma to identify those who filled a short-acting beta agonist, oral corticosteroid, or inhaled corticosteroid within 3 days of discharge. We used a multivariable extended Cox model to investigate the association of recommended medication fills and hospital readmission within 90 days.

Results

Of 31 658 children hospitalized, 55% filled a beta agonist prescription, 57% an oral steroid, and 37% an inhaled steroid. Readmission occurred for 1.3% of patients by 14 days and 6.3% by 90 days. Adjusting for patient and billing provider factors, beta agonist (hazard ratio [HR] 0.67, 95% CI 0.51, 0.87) and inhaled steroid (HR 0.59, 95% CI 0.42, 0.85) fill were associated with a reduction in readmission at 14 days. Between 15 and 90 days, inhaled steroid fill was associated with decreased readmission (HR 0.87, 95% CI 0.77, 0.98). Patients who filled all 3 medications had the lowest readmission hazard within both intervals.

Conclusions

Filling of beta agonists and inhaled steroids was associated with diminished hazard of early readmission. For inhaled steroids, this effect persisted up to 90 days. Efforts to improve discharge care for asthma should include enhancing recommended discharge medication fill rates.

Section snippets

Methods

We conducted a retrospective cohort study of Medicaid analytic extract (MAX) claims data for 12 states from 2005-2007. The protocol for the conduct of this study was reviewed and determined not to be human subjects' research by the Children's Hospital of Philadelphia Institutional Review Board. MAX claims include distinct files for personal summary data, inpatient, outpatient drug, and other services' claims, the last of which includes outpatient and emergency department (ED) visits. For the

Results

Between January 1, 2006, and September 3, 2007, 31 658 children were admitted to an inpatient unit for asthma. The cohort were 39% female, 37% non-Hispanic Black, 22% non-Hispanic white, and 32% Hispanic. The majority (61%) were covered by a managed care plan at the time of index hospital discharge; the remainder were covered by fee-for-service plan. The mean age of the cohort was 6.6 years (SD 4.3). The 5 most prevalent hospital-level comorbidities were pneumonia (15%), hypoxemia (12%), upper

Discussion

In this study of Medicaid claims, approximately 55% of children hospitalized for asthma filled a prescription for a beta agonist or oral steroid within 3 days of discharge and 37% filled an inhaled steroid prescription. Those who filled prescriptions for short-acting beta agonists and inhaled steroids experienced early readmission less frequently than children who did not, and those who filled inhaled corticosteroids experienced 15- to 90-day readmission less frequently than those who did not.

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      Citation Excerpt :

      One study examined the relationship between medication fills prior to discharge and readmissions. A study of Medicaid claims found that filling either a beta-agonist, ICS, or OCS prescription prior to discharge was associated with a decreased odds of early readmission.65 Filling all 3 medications prior to discharge was associated with a significant reduction in early readmissions (OR 0.32; 95% CI 0.16-0.60).

    View all citing articles on Scopus

    C.K. received funding from an Academic Pediatric Association Young Investigator Award and salary support from the Robert Wood Johnson Clinical Scholars program. The authors declare no conflicts of interest.

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