Childhood Asthma Hospital Discharge Medication Fills and Risk ofSubsequent Readmission
Chén C. Kenyon, David M. Rubin, Joseph J. Zorc, Zeinab Mohamad, Jennifer A. Faerber,Chris Feudtner
DOI:
http://dx.doi.org/10.1016/j.jpeds.2014.12.019 Abstract
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 ysis of Medicaid ytic Extract files from 12 geographically diverse states from 2005-2007. We linked inpatient hospitalization, outpatient, and prescription claims records for children ages 2-18years with an index hospitalization for asthma to identify those who filled a short-acting beta agonist, oral corticosteroid, or inhaled corticosteroid within 3days of discharge. We used a multivariable extended Cox model to investigate the association of recommended medication fills and hospital readmission within 90days.
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 14days and 6.3% by 90days. 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 14days. Between 15 and 90days, 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 90days. Efforts to improve discharge care for asthma should include enhancing recommended discharge medication fill rates.
