Funding outcome

When a child has asthma, the disease may be worse at certain times and a child may need to visit the emergency department (ED) to get care. The child would flow through different key stages. First, the child would be registered in the ED. Next the patient would have the physician initial assessment, i.e., when a physician first sees the patient. At some point, a physician would make a decision about whether or not the child can be discharged home. Finally, a child will leave the ED because s/he is discharged or will leave the ED because s/he is admitted or transferred to another hospital. The length of time in each stage and how the lengths of time change because of different features of the child and the ED visit is of interest in this study. This project will use health data routinely collected and analyze all 25,388 ED visits for asthma made by 16,056 children aged 2 to 17 in 18 high-volume EDs in Alberta from 2010 to 2015. We will define multistate models with states including registration, physician initial assessment, disposition decision, and end of ED visit. The transitions between states will be modeled as functions of patient characteristics (e.g., age, gender) as well as ED visit characteristics (e.g., time of day) and measures of ED crowding. We expect that transitions to each state will differ by patient characteristics, ED visit characteristics,and measures of ED crowding. This study will be a novel examination of the flow of children with asthma through the ED and the impact of patient characteristics and ED visit characteristics such as ED crowding on the flow. Results of this study are important for patients, health providers and health administrators to further understand if there are any stages that could be shortened in order to reduce overall time in the ED and potentially reduce ED crowding.