332 - Characterizing Hospital-Based Provision of Longitudinal Asthma Care in Children ≤ 4 Years Old

Publication Number: 2321.332

Emese Kanyo, Children's National Health System, Washington, DC, United States; Megan L.. Smith, Children's National Health System, Washington, DC, United States; Kavita Parikh, Children's National Health System, Washington DC, DC, United States; Shilpa J.. Patel, Children's National Hospital, Bethesda, MD, United States; Jordan Tyris, Children’s National Hospital, Washington, DC, DC, United States

Background: Children experience asthma morbidity inequitably. Young children have the highest rates of asthma healthcare utilization but face unique healthcare system barriers due to the clinical uncertainty in diagnosing and managing early childhood asthma. Evidence-based longitudinal asthma care (LAC) provision at hospital discharge remains an understudied and underutilized, yet critical opportunity to mitigate these inequities.

Objective: Describe adherence to and disparities in guideline-recommended LAC provision for children ≤4 years old at hospital discharge.

Design/Methods: Single center, retrospective cohort study of hospitalizations in 2023-2024 with an asthma ICD-10 J45 diagnosis code among children ≤4 years old. Excluded children had medical complexity, a croup co-diagnosis, or did not receive systemic steroids. Guideline-recommended LAC outcomes were: 1) provider documented asthma severity, exacerbations in the past year, environmental triggers, social needs; and 2) care provision at discharge (short-acting beta agonist [SABA]; new/stepped up inhaled corticosteroid [ICS]; asthma action plan [AAP]; subspecialist referral). Demographic variables included age, sex, race/ethnicity, preferred language, and insurance type. Frequencies characterized adherence to LAC. Chi square and Fisher’s exact tests analyzed disparities in care provision by demographics.

Results: Of 238 included encounters, children often were >2 years old (84%), Non-Hispanic Black/African American (53%), preferred English (82%) and male (51%). Documentation of guideline-recommended assessments was low: 111 (47%) encounters documented asthma severity; 105 (44%) asthma exacerbations in the past year; 72 (30%) exposure to ≥1 environmental trigger; and 17 (7%) presence of ≥1 social need. Most children received SABA prescriptions (97%) and AAPs (84%), while 2/3 received a new/stepped up ICS prescription (65%) and subspecialist referral (65%). Children < 2y (versus 2-4y) less often received AAPs (65% v. 87%, p=0.0008), asthma specialist referrals (35% v. 70%, p< 0.0001) or SABA prescriptions (92% v. 99%, p=0.0497). No disparities were identified by race/ethnicity, insurance, sex, or language.

Conclusion(s): In this cohort, there were disparities in LAC provision by age as well as infrequently documented assessments that critically inform asthma care plans (e.g., asthma severity, past exacerbations) and facilitate comprehensive care (e.g., environmental triggers, social needs). Hospital-based interventions that facilitate documentation of asthma assessments and standardize LAC provision may help mitigate inequities in early childhood asthma morbidity.