Follow-Up Care After an Emergency Department Visit for Asthma and Subsequent Healthcare Utilization in a Universal-Access Healthcare System
Bibliographic record
Abstract
To describe the follow-up care for asthmatic patients within 28 days of an emergency department (ED) visit and its association with ED revisits and hospital admissions in the subsequent year.In this study, 29 391 children with asthma between the ages of 2 and 17 treated in an ED in Ontario, Canada, between April 16, 2006, and February 28, 2009, had their chart reviewed in a population-based retrospective cohort study. Multiple linked health administrative data sets available through the Institute for Clinical Evaluative Sciences were used to gather data.Data were collected by using the National Ambulatory Care Reporting System, Canadian Institute for Health Information Discharge Abstract Database, and Ontario Health Insurance Plan claims database to identify ED visits, hospital admissions, and outpatient visits, respectively. Only children with preexisting asthma were chosen for the study. The primary and secondary outcomes were the number of children having an ED visit and those having a hospital admission for asthma within 29 to 365 days, respectively. Statistical analysis was done by using SAS (SAS Institute, Inc, Cary, NC) for UNIX.Of the 29 391 children, 32.8% had a follow-up, 22.1% had an ED revisit, and 2.7% had a hospital admission. Having a follow-up visit was not found to be associated with ED revisit or hospitalizations (hazard ratio, 0.98; 95% confidence interval, 0.93–1.03 and hazard ratio, 1.06; 95% confidence interval, 0.92–1.23, respectively). Younger children, those who were in the lower income quintile, and those with more severe acute or chronic asthmatics at the time of ED visits were more likely to have ED revisits and hospitalizations. Other characteristics such as number of visits and type of physician providing care were not associated with outcomes.Follow-up care was not accessed after an ED visit for asthmatic patients even in a universal health care setting. Those that did have follow-up had no association with reduced ED revisits and hospitalizations in the subsequent year.This study highlights the discrepancy between the factors we usually think are associated with good follow-up care for asthmatic patients presenting to the ED and what actually happens. Even with universal health care and accessibility, poor follow-up outcomes can still occur, thus it is important to work toward identifying other factors that have a greater impact on follow-up, ED revisits, and hospitalizations. Ultimately identifying these factors can help us to better manage and control our asthmatic patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".