Asthma Outcomes in Pediatric Patients With 30-Day Follow-up After an Asthma Hospitalization in a Medicaid-Managed Care Program

To evaluate whether a follow-up visit within 30 days of a pediatric asthma hospitalization affects the risk of future asthma-related hospitalizations and emergency department visits.The study population included 1,485 children between the ages of 1 and 18 years who were hospitalized for asthma between January 2012 and December 2018. Patients had to be enrolled in a Texas Medicaid managed care plan and were excluded if they had a severe chronic disease other than asthma.This was a retrospective cohort study in which claims data were used to identify pediatric patients hospitalized for asthma from 2012 to 2018. The first asthma hospitalization within the study period was defined as the index hospitalization. The primary exposure was an outpatient follow-up visit for asthma within 30 days of the index hospitalization. The primary outcome was time to rehospitalization or emergency department visit for asthma within 30 to 365 days after the index hospitalization.Among 1,485 children, 46% had an outpatient follow-up appointment within 30 days of the index hospitalization. There was no statistically significant association between completing a follow-up appointment and the risk of rehospitalization or emergency department visits for asthma within the following year. Children who completed follow-up with a pulmonologist were at a higher risk for rehospitalization (adjusted hazard ratio 3.29, 95% confidence interval = 1.48–7.32) and emergency department visits (adjusted hazard ratio 1.80, 95% confidence interval = 1.19–2.71). Outpatient follow-up within 30 days was associated with higher dispensing rates of short-acting beta agonists and inhaled corticosteroids.An outpatient follow-up appointment within 30 days of an asthma hospitalization was not associated with a change in the rate of asthma-related hospitalizations or emergency department visits within the following year.Pediatric patients who are hospitalized for asthma are at increased risk for readmission. Established guidelines recommend close follow-up after an asthma hospitalization. Although this study did not find an association between timely follow-up and reduced healthcare utilization, the authors identified that the low dispensing rate of inhaled corticosteroids during follow-up may have contributed to the lack of benefit. This study highlights the importance of improving both access to care and the quality of care for children who have been previously hospitalized for asthma.