Using longitudinal data on readmission rates to guide and evaluate interventions to control pediatric asthma

Controlling Asthma in the Richmond Metropolitan Area (CARMA), primarily funded by the CDC, uses outcome and impact evaluations to assess community-driven interventions to improve the management of pediatric asthma. CARMA began a two year planning phase in 1999 and a five year implementation in 2001. One impact evaluation measure is based on hospital discharge records, obtained from Virginia Health Information, for patients aged 2-18 with a primary diagnosis of asthma (ICD9-CM code 493.xx.). Asthma admissions are typically included in the list of conditions that should be avoidable with appropriate ambulatory care, are widely used as a flag for uncontrolled asthma and since 2000 have been used by the National Committee for Quality Assurance as one measure for defining persistent asthmatics. The evaluation strategy compares the CARMA catchment area to a demographically similar area. This presentation focuses on the analysis of multiple admissions for the period 1994-2005. Statewide, the likelihood of a given child having more than one admission in any year varied over the course of the 12-year period (×2 =131, p < .0001), rising from 38% in 1994 to 49% in 2000, then declining to 35% in 2005. While the pattern of multiple admissions in CARMA and the comparison area resembled the statewide pattern, CARMA and the comparison area differed significantly in the percentage of children with multiple admissions over the 12-year period (CMH 65, p <.0001). The presentation will include discussion of the challenges of analyzing, interpreting and using this data to guide interventions.