Outcome Measures
| Exacerbation Events | Pre-Intervention Period | Post-Intervention Period | P Value |
|---|---|---|---|
| Total exacerbations | 386 | 414 | |
| Patients with no exacerbations, N (%) | 2410 (89.7) | 2389 (88.9) | .3‡ |
| Exacerbations per person among those with 1 or more exacerbations, Median (IQR) (min, max) | 1 (1–1) (1,9) | 1 (1–1) (1,8) | 1.0‡ |
| Percent of exacerbations with a qualifying event of type:* | |||
| Type 1: single ED or IP visit with primary diagnosis of asthma | 112/386 (29.0) | 109/414 (26.3) | .3‡ |
| Type 2: cluster of 2 visits with 1 to 14 days between, both with an asthma diagnosis | 85/386 (22.0) | 89/414 (21.5) | .5‡ |
| Type 3: ICD code (5th digit) or string indicating exacerbation | 220/386 (57.0) | 245/414 (59.2) | .3‡ |
| Type 4: systemic corticosteroid within 0 to 3 days after any type of visits for asthma | 265/386 (68.7) | 275/414 (66.4) | .4‡ |
| Healthcare utilization | |||
| 1. IP visits with primary asthma diagnosis (number of visits) | 5 | 1 | — |
| 2. ED visits with primary asthma diagnosis (number of visits) | 131 | 121 | — |
| 3. Outpatient visits with an asthma diagnosis (number of visits) | 1888 | 1910 | — |
| 4. Asthma-specific medication use (n prescriptions)† | 5,221 | 7,116 | — |
| 4a. Controller use | 2,224 | 2,987 | |
| 4b. Reliever use | 2,997 | 4,129 | |
| Healthcare utilization—number of patients with at least 1 of the following: | |||
| 1. IP visit with primary asthma diagnosis | 5/2687 (0.2) | 1/2687 (0.0) | .1 |
| 2. ED visit with primary asthma diagnosis | 83/2687 (3.1) | 92/2687 (3.4) | .4 |
| 3. Outpatient visits with an asthma diagnosis | 609/2687 (22.7) | 649/2687 (24.2) | .1 |
| 4. Asthma-specific medication use† | 1094/2687 (40.7) | 1334/2687 (49.6) | <.0001 |
| 4a. Controller use | 468/2687 (17.4) | 585/2687 (21.8) | <.0001 |
| 4b. Reliever use | 1005/2687 (37.4) | 1240/2687 (46.2) | <.0001 |
| Composite scores: ACT | |||
| Observations, N | 0 | 543 | — |
| ACT score = “in control,” n (% of all ACTs) | n/a | 325 (60.2) | — |
| ACT score = “poorly controlled,” n (%) | n/a | 132 (24.4) | — |
| ACT score = “very poorly controlled,” n (%) | n/a | 83 (15.4) | — |
| Pulmonary physiology: FEV1/FVC percent predicted | |||
| Observations, N | 13 | 456 | — |
| Mean value, % predicted, (standard deviation) | 82.5 (11.1) | 77.9 (13.1) | .1‡ |
ACT, asthma control test; ED, emergency department; IP, inpatient; OP, outpatient; IQR, interquartile range.
↵* Percentages add up to greater than 100% as an exacerbation may have more than one qualifying event.
↵† This includes controllers and relievers but not steroids.
↵‡ Random effects for subject were included when applicable.