535 - Decrease in Pediatric ED Visits for Asthma during Covid 19 Pandemic

Poster Number: 535
Publication Number: 535.242

Judith Groner, Nationwide Children's Hospital, Columbus, OH, United States; Stephen Hersey, Nationwide Children's Hospital, Columbus, OH, United States; Jessica Retzke, Nationwide Children's Hospital, Columbus, OH, United States; Charles Hardy, Nationwide Children's Hospital, Columbus, OH, United States; Lisa Nicholson, Medline, Dublin, OH, United States; Lisa Ulrich, Nationwide Children's Hospital, Columbus, OH, United States

Background: Asthma is the leading chronic disease of childhood, affecting 8% of the pediatric population in the US. Children from lower socioeconomic status (SES) are more heavily burdened by asthma than those from higher SES. Children who are younger than 18 and insured by Medicaid account for over 600,000 Emergency Department (ED) visits each year, resulting in healthcare costs exceeding $272 million. Our hospital system had initiated a comprehensive Quality Improvement (QI) based approach to reducing ED visits for patients seen within a multisite Primary Care Network (PCN) in 2010. Over 10 years, there were steady decreases in ED rates for asthma utilization among PCN patients corresponding to stepwise guideline-based interventions. In mid March 2020, schools shut down because of Covid 19 and there was a temporary ‘Stay at Home’ order in the city. The impact of this change on asthma ED rates was then unknown.

Objective: Our objective is to demonstrate the temporal relationship between ED visits for asthma of patients who receive primary care at the PCN during 2020.

Design/Methods: Setting: Primary Care Network system run by an urban Midwest children’s hospital, staffed by over 80 providers (pediatricians and nurse practitioners) across 11 community sites in Columbus Ohio, serving a predominantly Medicaid insured population. The PCN cared for over 10,000 children with asthma in 2020. Data collection: We present yearly data in the Chart (attached) from the initiation of the comprehensive QI initiative to reduce ED visits for PCN patients in 2010. The data is displayed as the rate of ED visits per 1000 members for each year going back to 2010. Analysis: Poisson regression models were applied to examine the differences in ED visits and rates across years.

Results: After a slow but steady decline in ED visits for asthma (except 2014, increase attributable to enterovirus D68) coinciding with continuous QI work, there was a precipitous decline in ED visits in 2020. In 2019 there were 14.5 asthma ED visits for PCN patients with asthma; in 2020 these visits were almost halved to 7.5 (pConclusion(s): A rapid and sharp decline in ED visits for asthma corresponded temporally to school down shut and “Stay at Home orders”. This observation indicates that person-to-person spread of viral illnesses may be the predominant cause of asthma exacerbations, despite known relationships between indoor allergens such as pet dander, molds, and dust, and secondhand smoke exposure as asthma triggers.
NCH Asthma ED Visit Rate per 1000 Primary Care Network Patients*p < .0001 from 2019 (14.5 asthma ED visits) versus 2020 (7.5 asthma ED visits) per 1000 PCN patients
** data for 2021 complete through end of November 2021