Impact of an interdisciplinary asthma care network on emergency department visits and hospitalizations

Background — Current national and international asthma clinical practice guidelines emphasize care continuity and adherence to guideline-based care delivered through interdisciplinary teams. However, the efficacy of such teams in reducing urgent asthma-related care has not yet been assessed.

Objective — To measure the impact of an interdisciplinary asthma care network (ACN) on health services utilization.

Methods — We identified a retrospective cohort of individuals with confirmed or suspected asthma who received specialized interdisciplinary asthma care in Southeastern Ontario, Canada between 2009–2018. Individuals were matched (on age, sex, and year of asthma diagnosis) to controls with suspected asthma who were not enrolled in the ACN. Asthma-related emergency department (ED) and inpatient visits were compared via zero inflated Poisson regression, stratified between pediatric and adults.

Results — 1248 ACN patients were matched to 3629 non-ACN controls. Asthma-related ED visits were reduced for 21% of ACN patients versus 6.7% of non-ACN participants. Similarly, hospitalizations were reduced for 10.7% of ACN participants post-index visit compared to 1.4% of non-ACN participants (both P<0.001). Despite higher pre-enrolment health service utilization, ACN adults no longer had higher health service use compared to non-ACN, after enrolment in the network (Risk Ratio: 1.3 (0.9–1.88)). Pediatric ACN patients continued to have higher health service use compared to non-ACN participants post-enrolment (Risk Ratio 1.72 (1.30–2.26)).

Conclusion — Enrolment in a guideline-based interdisciplinary ACN reduces acute, unplanned asthma-related health service utilization, particularly in adults. Despite higher pre-enrolment health service utilization, adults enrolled in guideline-based interdisciplinary asthma care no longer had higher service use following enrolment.