Patterns and predictors of asthma-related emergency department use in Harlem

Study objectives: To assess the roles of poor access to care, psychological risk factors, and asthma severity in frequent emergency department (ED) use. Design: A cross-sectional survey. Setting: Harlem Hospital Center ED and outpatient chest clinic. Participants: Three hundred seventy-five adult residents of Harlem, a predominantly African-American community in New York City. Measurements: Asthma severity was assessed by self-reported symptoms using National Asthma Education and Prevention Program guidelines, health-care utilization, and psychometric scales. Results: Respondents with more severe asthma were more likely to have a primary asthma care provider, and to have had more scheduled office visits for asthma in the year prior to the interview (mean number of visits for patients with severe asthma, 3.6 visits; moderate asthma, 2.4 visits; and mild asthma, 1.7 visits). Despite having a regular source of care, 69% of respondents identified the ED as their preferred source of care; 82% visited the ED more than once in the year prior to interview (median, four visits). Persons with moderate or severe asthma were 3.8 times more likely to be frequent ED users compared to those with mild asthma (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2 to 6.6). This was the strongest predictor of frequent ED use. Other predictors of ED use were number of comorbid disorders (OR, 1.5; 95% CI, 1.1 to 2.1) and self-reported global health in the year prior to the ED visit (OR, 1.8; 95% CI, 1.2 to 2.7). Psychological characteristics were not predictive of frequent ED use when controlling for disease severity. Conclusions: Frequent ED users present with serious medical conditions. They do not substitute physician care with ED care; they augment it to address serious health needs.