Factors Driving High Hospitalization Rates of Asthma Frequent Flyers: A Repeat Cross-Sectional Study – Age,Comorbidities,and Access to Healthcare

Abstract

Background:

Frequent flyer hospital visits account for a disproportionately large share of overall visits and costs. A 2011-2012 Intermountain Healthcare study investigated factors driving high hospitalization rates of asthma frequent flyers. We repeated this study on new subjects for 2019-2021 to detect changes in demographics, treatment, comorbidities, and non-compliance. No initiatives were implemented following the original study, except for the Pulmonary Disease Navigator (PDN) scope being expanded in 2019 to include asthma.

Methods:

For 2019, 2020, and 2021, we extracted adult subjects assigned an asthma exacerbation diagnosis associated with ≥ 4 visits (ER or admission) per year at all Intermountain hospitals. We performed retrospective electronic medical record reviews on these subjects, including all variables from the original study. Chi-square analysis was used to assess differences between cohorts in age and access to healthcare. For cohort differences in comorbidities, each variable was compared with a z-test. We collected an additional year of data for insight prior to the COVID-19 pandemic. We excluded pediatric subjects as the original study found that outcomes were better than for adults.

Results:

We identified 112 subjects with ≥ 4 visits per year during 2019-2021. There was a significant difference between cohorts in proportions of obesity and access to healthcare. 12% of the subjects in the current cohort are followed by a PDN. For 2019-2021, we noted a downward trend in admissions, ER visits, and 30-day readmissions per year. Other results are reported in accompanying abstracts.

Conclusions:

Compared to the original cohort, a larger proportion of subjects in the current cohort is obese, aligning with increased national BMI over the past decade. There is also an increased proportion of subjects with Medicaid and decreased self-pay, likely due to the Affordable Care Act. As a result, subjects may be more likely to seek and receive care. The minimal change in the remaining comorbidities, age, and variables in accompanying abstracts suggests that asthma frequent flyer management has made little progress since the original study, possibly due to a lack of initiatives implemented and minimal subjects being followed by a PDN. This study was limited by having no access to the original dataset. We conclude that there has been an increase in obesity, and, due to no clear adjustments in the management of asthma frequent flyers, we recommend increased utilization of PDNs.