Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
6221095 | The Journal of Pediatrics | 2015 | 7 Pages |
ObjectiveTo assess the relationship between posthospitalization prescription fills for recommended asthma discharge medication classes and subsequent hospital readmission.Study designThis was a retrospective cohort analysis of Medicaid Analytic Extract files from 12 geographically diverse states from 2005-2007. We linked inpatient hospitalization, outpatient, and prescription claims records for children ages 2-18Â years with an index hospitalization for asthma to identify those who filled a short-acting beta agonist, oral corticosteroid, or inhaled corticosteroid within 3Â days of discharge. We used a multivariable extended Cox model to investigate the association of recommended medication fills and hospital readmission within 90Â days.ResultsOf 31â658 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 14Â days and 6.3% by 90Â days. 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 14Â days. Between 15 and 90Â days, 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.ConclusionsFilling of beta agonists and inhaled steroids was associated with diminished hazard of early readmission. For inhaled steroids, this effect persisted up to 90Â days. Efforts to improve discharge care for asthma should include enhancing recommended discharge medication fill rates.