Date of Award

Winter 2000

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program/Concentration

Urban Services--Health Services

Committee Director

Clare Houseman

Committee Member

Cheryl Samuels

Committee Member

Rchardean Benjamin-Coleman

Committee Member

Brenda Nichols

Abstract

Asthma is the most common chronic illness of childhood. Pediatric asthma hospitalization rates and costs of care have risen in recent years. Readmissions, an adverse outcome often used to monitor quality of care, may account for the increase in asthma hospitalization rates. This research examined selected hospital and patient risk factors related to asthma readmissions, using Donabedian's framework for structure, process, and outcomes to assess the quality of care for children with asthma. Outcome measures included readmission for asthma within one year of initial hospitalization, readmission within 30 days, and multiple readmissions within one year. Structure factors measured were insurance type, hospital size, and hospital volume of annual admissions, while process factors measured were length of stay, previous admissions for asthma in the prior year, and use of inhaled steroids during the initial hospitalization.

This study used hospital discharges for asthma from 21 children's hospitals, which included 7,848 children admitted at least once for asthma in 1996. Logistic regression was used to determine significant structure and process factors associated with asthma readmission. Adjusting for age, gender, race, and APR-DRG severity of illness, insurance type was a significant predictor of asthma readmission within one year. Hospital volume was a significant predictor of asthma readmission within one year, multiple asthma readmissions, and readmission within 30 days of initial hospitalization. Length of stay was a significant predictor of asthma readmission within one year and multiple asthma readmissions. Previous admission for asthma was a significant predictor of asthma readmission within one year, multiple asthma readmissions, and readmission within 30 days. Use of inhaled steroids in the initial hospitalization was a significant predictor of asthma readmission within one year. Hospital size was not a significant predictor of asthma readmission within one year, multiple asthma readmissions, or readmission within 30 days.

Children admitted for asthma with public insurance, children admitted to large volume hospitals, children with over one day length of stay, children who had at least one previous admission for asthma, and children who used inhaled steroids in the initial hospitalization were more likely to be readmitted for asthma within one year of initial hospitalization.

DOI

10.25777/bx6e-q825

ISBN

9780496385362

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