Developing a risk stratification model for predicting future health care use in asthmatic children.

Jill R. Hanson, Children's Mercy Hospital
Brian R Lee, Children's Mercy Hospital
David D. Williams, Children's Mercy Hospital
Helen Murphy, Children's Mercy Hospital
Kevin Kennedy, Children's Mercy Hospital
Stephen A. DeLurgio, Children's Mercy Hospital
Jay Portnoy, Children's Mercy Hospital
Mamta Reddy, Children's Mercy Hospital


BACKGROUND: Previous studies have stratified pediatric asthma patients for risk of future exacerbation and/or health care use, but most incorporate multiple clinical parameters.

OBJECTIVE: To determine whether historical acute care visits (ACVs) alone could predict risk of future health care use.

METHODS: Children seen for asthma in an outpatient visit during a 3-year period were identified. The number of ACVs in the 12 months before and after the outpatient visit was determined. Logistic regression models were used to determine the odds of a future ACV. Models were adjusted for age, sex, race, and insurance status.

RESULTS: Of 28,047 outpatient visits, 21,099 (75.2%) had no historical ACVs. The probability of a future ACV increased from 30% with one historical ACV to 87% with 5 or more historical ACVs. Outpatient visits with one historical ACV had significantly higher odds of a future ACV compared with those with no historical ACVs (adjusted odds ratio [OR], 3.60; 95% confidence interval [CI], 3.14-4.12; P < .001). The OR increased with each additional historical ACV to an adjusted OR of 58.71 (95% CI, 24.34-141.61; P < .001) with 5 or more historical ACVs. Outpatient visits with 5 or more historical ACVs represented only 1.1% of the study sample but accounted for a higher mean number of future ACVs.

CONCLUSION: The historical count of ACVs was predictive of future ACVs. A significant increase in the probability of future ACVs was observed with each additional historical visit, effectively stratifying risk by the historical visit count. Notably, a small group of patients accounted for a disproportionate number of future ACVs.