Factors Driving High Hospitalization Rates of Asthma Frequent Flyers: A Repeat Cross-Sectional Study – PFTs and Pulmonology Consults

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. To assess differences between cohorts in PFTs and pulmonology consults, 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. No significant differences between cohorts were detected. For the 2019-2021 cohort, we found that 12% of subjects are followed by a PDN, and 75% of PFTs were ordered by a pulmonologist. For 2019-2021, we noted a downward trend in admissions, ER visits, and 30-day readmissions. Other results are reported in accompanying abstracts.

Conclusions:

Compared to the original cohort, the proportion of subjects that received PFTs and pulmonology consults did not change significantly. There may have been a reduction in PFTs and an increase in consults, but further research would be required to verify this. This lack of change aligns with few subjects in the current cohort being followed by a PDN. Additionally, results in accompanying abstracts demonstrate that although some variables have shifted, the 2019-2021 asthma frequent flyers are considerably similar compared to the original cohort, suggesting that educating and treating these patients has made little to no progress since the original study. Reduction in total visits per year and the possible reduction in PFTs may be attributed to COVID-19. This study was limited by having no access to the original dataset. Due to a plausible lack of progress, we advocate increased involvement of PDNs in the management of frequent flyer asthma patients.