Table 4.
Item on the left-hand side of the rule | Implication of the item | Intervention compiled for the item | |
Rule 1: The patient had ≥12 EDa visits in the past year AND the patient had ≥21 distinct medications in all of the asthma medication orders in the past year → the patient will incur one or more asthma hospital visits in the subsequent year. | |||
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The patient had ≥12 ED visits in the past year | Having many ED visits reflects poor asthma control | Implement control strategies to avoid the need for emergency care |
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The patient had ≥21 distinct medications in all of the asthma medication orders in the past year | Using many asthma medications reflects poor asthma control | Tailor prescribed asthma medications and help the patient maximize asthma control medication adherence |
Rule 2: The patient had ≥9 distinct asthma medication prescribers in the past year AND the block group where the patient lives has a national health literacy score [42] ≤244 AND the patient had ≥21 distinct medications in all of the asthma medication orders in the past year → the patient will incur one or more asthma hospital visits in the subsequent year. | |||
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The patient had ≥9 distinct asthma medication prescribers in the past year | Having many asthma medication prescribers reflects poor care continuity, which often leads to poor outcomes | Provide the patient with social resources to address social chaos that leads to ineffective access to health care |
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The block group where the patient lives has a national health literacy score ≤244 | Having low health literacy is correlated with poor outcomes | Improve education access in the area where the patient lives to help increase health literacy |
Rule 3: The patient had a total of ≥25 units of systemic corticosteroids ordered in the past year AND the patient had ≥12 ED visits in the past year AND the patient is Hispanic → the patient will incur one or more asthma hospital visits in the subsequent year. | |||
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The patient had a total of ≥25 units of systemic corticosteroids ordered in the past year | Systemic corticosteroids are one type of asthma medication intended for short-term use to relieve acute asthma exacerbations. Using a lot of systemic corticosteroids reflects poor asthma control | Tailor prescribed asthma medications and help the patient maximize asthma control medication adherence |
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The patient is Hispanic | In the US, Hispanic people have a disproportionately high rate of poor asthma outcomes | —b |
Rule 4: The patient had ≥4 major visits for asthma in the past year AND the patient is between 11 and 35 years old AND the patient had no outpatient visit in the past year AND the average length of an inpatient stay of the patient in the past year is >1.75 and ≤2.95 days → the patient will incur one or more asthma hospital visits in the subsequent year. | |||
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The patient had ≥4 major visits for asthma in the past year | As defined in our paper [23], a major visit for asthma is an inpatient stay or ED visit having an asthma diagnosis code, or an outpatient visit having a primary diagnosis of asthma. Intuitively, all else being equal, a patient having major visits for asthma has a higher likelihood of incurring future asthma hospital visits than a patient having only outpatient visits with asthma as a secondary diagnosis | Implement control strategies to avoid the need for emergency care |
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The average length of an inpatient stay of the patient in the past year is >1.75 and ≤2.95 days | Having inpatient stays reflects poor asthma control | Implement control strategies to avoid the need for emergency care |
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The patient had no outpatient visit in the past year | For good asthma management, a patient with asthma is supposed to see the primary care provider regularly. Having no outpatient visit often implies that the patient has no primary care provider | Help the patient obtain a primary care provider if the patient does not already have one |
Rule 5: The patient had ≥4 major visits for asthma in the past year AND the patient's last ED visit is within the last 49 days AND the patient had between 6 and 8 distinct asthma medication prescribers in the past year AND the patient had a total of ≥36 units of asthma medications ordered in the past year AND >23.7% and ≤33.3% of families in the block group where the patient lives are below 150% of the federal poverty level → the patient will incur one or more asthma hospital visits in the subsequent year. | |||
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The patient’s last ED visit is within the last 49 days | Having a recent ED visit reflects poor asthma control | Implement control strategies to avoid the need for emergency care |
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The patient had a total of ≥36 units of asthma medications ordered in the past year | Taking many asthma medications reflects poor asthma control | Tailor prescribed asthma medications and help the patient maximize asthma control medication adherence |
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>23.7% and ≤33.3% of families in the block group where the patient lives are below 150% of the federal poverty level | Poverty correlates with poor outcomes | Provide living wage programs in the area where the patient lives to increase resources for health care |
aED: emergency department.
bNot applicable.