Readmission rates at three months for children hospitalized with acute asthma dropped when families received comprehensive education prior to discharge, according to research published in the Journal of Pediatrics. In fact, it was the only single component of discharge bundles that was strongly associated with lowered readmissions.
Under federal law, the Centers for Medicare and Medicaid Services provides lower reimbursement for hospitals that post poor readmissions rates in comparison to their peers, essentially a financial penalty tied to clinical quality.
According to the Centers for Disease Control and Prevention, asthma is the most common chronic lung disease of childhood, affecting roughly 6 million children in the U.S. Hospitalization for asthma accounts for $1.5 billion in annual hospital charges and represents almost a third of childhood asthma costs.
Children who are hospitalized for asthma have a roughly 20 percent chance of returning to the hospital in the next year, and individual hospital readmission rates can range from 5.7 percent to 9.1 percent at three months, according to the researchers. While the National Institutes of Health has published evidence-based guidelines for discharge planning, there is no single, standardized asthma discharge process used across all pediatric hospitals in the U.S. that impacts 30-day readmission rates.
The authors analyzed records from a national sample of tertiary care children's hospitals, looking at hospitalizations of 5- to 17-year-olds for acute asthma exacerbation in 2015. They characterized how frequently hospitals used 13 separate asthma discharge components by distributing an electronic survey to quality leaders.
The 45 hospitals that responded posted a median of 349 asthma discharges per year, and had a median adjusted readmission rate of 2.6 percent at 30 days and a 6.6 percent median adjusted readmission rate at three months. The most commonly used discharge components used for children with asthma were having a dedicated person providing education (76 percent), providing a spacer at discharge (67 percent) and communicating with a primary medical doctor (58 percent).
Aspects of discharge that help with reduced readmission rates at three months included comprehensive asthma education, complete with dedicated asthma educators; medications and devices provided to patients at discharge, such as spacers, beta-agonists, controller medication and oral steroids; communication and scheduled appointments with a primary medical doctor; and post-discharge activities, including home visits and referrals for environmental mitigation programs.
The authors recommended combining those strategies as much as possible to have the greatest possible impact on asthma-related readmissions.