PREDICTORS OF HOSPITAL-BASED CARE IN ASTHMA

The overall goal of this grant is to identify clinical predictors of
episodes of hospital-based care in people with asthma. This study is of
great practical importance because asthma is a common condition (3-5
percent of the population) which has a recent, unexplained rise in
morbidity and mortality. Many previous epidemiological studies have focused on predictors of
hospitalization for people with asthma seen in the emergency room. These
studies are of limited value for the practicing physician who sees the vast
majority of patients with asthma. This study will develop a key piece of
information needed for outpatient care of patients with asthma; a profile
of patients at risk for severe, potentially life-threatening exacerbations
of asthma. The experimental design is a prospective study of 800 patients
with asthma drawn from a large, pre-paid health care plan. The key
advantage of this population is that all the care occurs within the health
plan. Characteristics which will be identified include demographic
factors, socioeconomic status; patient characteristics such as tobacco use,
atopy, pattern of medication use, self-reporting of compliance/adherence,
attitudes about asthma; historical assessment of indoor air quality;
characteristics of asthma such as duration of asthma, lung function, and
variation in asthma symptoms; and speciality of physician. The outcome
measures will be obtained over a three year period and will include all
episodes of hospital-based care including hospitalizations, emergency room
visits, and urgency care clinic visits. Based on these data, models will
be developed which will assign relative risk to each of the independent
variables. These models will be validated in a subset of the population.
Results from this study will for the first time enable a profile to be
constructed of the high risk patient with asthma which includes
identification of modifiable risk factors. These results can be used for
physician and patient education programs as well as to target medical
intervention.