324 - Post-Discharge Dispensing of Inhaled Corticosteroids and 90-Day Reutilization in Children Hospitalized with Asthma

Publication Number: 2313.324

Alison R. Carroll, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; James W. Antoon, Vanderbilt University Medical Center, Nashville, TN, United States; Leonard Bacharier, Vanderbilt University Medical Center, Nashville, SD, United States; Stephanie Doupnik, Vanderbilt University School of Medicine, Nashville, TN, United States; Mert Sekmen, Vanderbilt University School of Medicine, Nashville, TN, United States; Kavita Parikh, Children's National Health System, Washington DC, DC, United States; Chen C. Kenyon, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Cristin Q. Fritz, Vanderbilt University Medical Center, Nashville, TN, United States; Kelsey Gastineau, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Derek Williams, Vanderbilt University Medical Center, Nashville, TN, United States

Background: Inhaled corticosteroids (ICS) improve asthma control and reduce asthma exacerbations and unplanned care. As such, ICS-containing medications are recommended in all children experiencing asthma-related hospitalization, a marker of poor asthma control. Contemporary data defining the prevalence of early post-discharge ICS dispensing and associations with asthma-related reutilization are needed.

Objective: To define the prevalence of early post-hospitalization ICS dispensing and associations with 90-day emergency department (ED) visits and hospitalizations for asthma.

Design/Methods: A retrospective cohort study of the 2022 Merative MarketScan Medicaid claims database from 10-12 U.S. states, for children (2-17 years) with an index hospitalization for asthma. We excluded children with medical complexity, children not discharged home, and children enrolled in Medicaid < 1 yr prior to hospitalization or < 3 months post-discharge. The primary exposure was early ICS dispensing (within 14 days of index discharge) compared to no ICS dispensing. Outcomes included ED revisit or hospitalization within 15-90 days of index discharge. Adjusted hazard ratios (aHR) were generated using Cox proportional hazard models while adjusting for relevant confounders (age, sex, index length of stay, comorbidities, month of admission by quarter, and prior asthma-related utilization) to estimate the association of early ICS dispending with time to asthma-related ED revisit and/or hospital readmission.

Results: There were 3057 index asthma hospitalizations (median age, 6 years; 57.1% male; 45.1% non-Hispanic Black). Of these, 1080 (35.3%) had an ICS dispensing within 14 days of discharge. Overall, 406 (13.3%) children had a repeat asthma-related reutilization event (ED revisit or readmission) within 15-90 days (median time to first reutilization, 44 days [IQR 21-68]), including 308 (10.1%) ED revisits and 116 (3.8%) hospitalizations. In adjusted analysis, early ICS dispensing was associated with significant reductions in any asthma-related reutilization (9.4% vs. 13.1%; aHR 0.71, 95% CI 0.57, 0.88), ED revisit only (7.1% vs. 9.5%; aHR 0.74, 95% CI 0.58, 0.94) and hospital readmission (2.2% vs. 3.6%; aHR 0.61, 95% CI 0.40, 0.94); Figure 1.

Conclusion(s): Early ICS dispensing following hospital discharge was associated with a decreased risk of asthma-related healthcare reutilization for both ED revisits and hospital readmissions. Identifying barriers and solutions to enhance ICS prescribing at hospital discharge may help reduce unnecessary healthcare reutilization.

Figure 1. Cumulative incidence of no reutilization event and adjusted hazard ratios (aHR, 95% CI) for the association of ICS dispensing within 14 days of discharge compared to no ICS dispensing.