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Rate of emergency department visits with a primary cause of asthma per 10,000 children under age 5

Current Value




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Story Behind the Curve

Updated: February, 2024

Author: Vermont Asthma Program, Vermont Department of Health

This indicator, or population measure, is part of our Healthy Vermonters 2030 data set. Read more about how this data helps us understand and improve the well-being of people in Vermont on the Healthy Vermonters 2030 webpage.

Because this data is meant to show how the health of our state changes during the decade from 2020-2030, some indicators may have very few data points for now. Keep checking back to see the progress our public health system and partners are making.

By 2030, we want to see this indicator decrease to a rate of 25 emergency department visits with a primary cause of asthma per 10,000 children under age 5. This target was chosen as a decrease from 35 to 25 ED visits with a primary diagnosis of asthma will be a statistically significant change.

The current graph shows only the baseline rate of emergency department visits with a primary cause of asthma with more data to come throughout the decade. However, the rate has been decreasing since 2016 and decreased sharply in 2020 due to Covid. There has been a similar general downward trend in the rate of hospitalizations for asthma among children under 5 years of age over the past decade.

The reason for the decreasing rate of asthma-related emergency department visits, like asthma-related hospitalizations, is unclear but may be due to a program of comprehensive asthma control efforts started in 2009 by the Vermont Asthma Program to expand efforts to promote national asthma best practices with support of several 5-year CDC asthma grant cycles. With improvements in clinical care best practices and Vermonters’ refining self-management knowledge and skills, asthma is being kept under control. 

Early initiatives have included support of regional hospitals with high asthma prevalence to provide home visiting for environmental trigger identification and elimination of those things that can exacerbate asthma and provide intensive asthma self-management education (AS-ME) to persistent uncontrolled or high-risk patients. These partners also worked to develop clinical protocols to improve asthma-related hospital discharge patient engagement to reduce readmissions. In recent years, the program has focused on promoting the spread of initiatives and best practices to additional regional hospitals and engaging partners with potential statewide reach to improve access to care for all Vermonters impacted by asthma. Two Learning Collaboratives of health care providers have been implemented to expand knowledge and support adoption by health care providers of national asthma guideline care standards and best practices, including preparing and sharing annual asthma action plans, screening, counseling, treating and/or referring for tobacco use /vaping or secondhand smoke exposure, and monitoring patient outcomes, such as emergency events, asthma control and proper inhaler device use.

The Vermont Asthma Program worked with clinical partners to disseminate Asthma Action Plans which are a validated tool for educating patients on how to manage asthma. The Program supports expansion of asthma self-management education in various settings in high-burden areas, including the University of Vermont Pediatrics and Northeast Vermont Regional Hospital to enhance remote educational services and home weatherization. This includes convening the AS-ME Network to train school nurses on asthma self-management education (AS-ME) and national guideline care to support professional development around asthma care and to expand asthma friendly best practices in schools, including delivery of AS-ME to students with uncontrolled asthma who are at risk of missed school and/or poor performance and concentration due to uncontrolled asthma.

The impact of COVID-19 and public health responses will also need to be monitored. Some health care providers are observing that the distancing, isolating, and other protective practices for COVID may have contributed to the additional drop in asthma-related emergency visits, but as we emerge from the pandemic, they are seeing more and more children struggling with uncontrolled asthma.

Another reason for the general decrease over time could be from the myriad of initiatives hospitals and federal programs have been employing to reduce costs across the board. We also hear from clinical partners that diagnosing asthma in young children is difficult. Viral infections and other respiratory infections can mimic the asthma symptoms of wheezing and coughing. For this reason, it may be necessary to confirm a definite diagnosis of asthma after the child is older (greater than 5 years).

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Why Is This Important?

Emergency department visits, as with hospitalizations for children, are serious, costly, and disruptive for families. The emergency visits, a clear sign that asthma is uncontrolled, may indicate some type of barrier to good asthma management – either due to access to care (e.g., scheduling of doctor visits, costs of medications), poor adherence to a treatment plan (improper device use, disruptions in medications), or environmental risk factors (e.g. extreme heat or cold, wood or tobacco smoke and vapors, allergies) aggravating symptoms. Emergency department visits due to asthma could be reduced if asthma is managed according to established guidelines. Effective management, including following one’s treatment plan, taking medications as prescribed even when symptoms are not present, confirming proper device use, and avoiding exposure to personal risk factors that trigger exacerbations, is key. Regular visits with the child’s medical home, keeping up to date with immunizations, completing asthma patient education, and observing other health promoting supports can help ensure good asthma control, and avoid asthma-related emergencies. Read more about asthma management from the National Heart, Lung, and Blood Institute.

This indicator is part of Healthy Vermonters 2030 which documents the health status of Vermonters at the start of the decade. The data can inform the public, health care providers, including school nurses, individuals and families impacted by asthma of how Vermont is doing with asthma management and control.

Equity and Impact

The burden of asthma is not distributed the same either across the country or within Vermont. Vermont is among the top five states in the country with high prevalence rates of asthma. Within Vermont, certain subpopulations are burdened with disproportionately high asthma rates. The Vermont Asthma Program (VAP) relies on strong Health Surveillance to identify the burden, disparities and service gaps and works with the Asthma Advisory Panel during Strategic Planning to identify priority populations. These include: 1) regional hotspots; 2) renters; 3) Vermonters of low socioeconomic status; 4) High asthma prevalence/low asthma action plan schools; and 5) Vermonters who smoke with a focus on pregnant women/new mothers.  VAP works with partners that serve these populations to support their efforts at reducing disparities in asthma-related outcomes among these and other priority populations.

Many of VAP’s strategies are reflective of CDC’s entire EXHALE Technical Package of asthma best practices designed to principally to reduce pediatric asthma-related emergency department visits and hospitalization (CDC’s CCARE goals) and to reduce asthma morbidity, mortality, and disparities through leveraging strategic partnerships to provide better care, improve health and lower costs.

VAP has regular engagement with representatives of the Vermont’s Department of Health’s Health Equity Team and the Division of Health Promotion and Disease Prevention (HPDP’s) Disabilities Manager to review and enhance the program’s identification of populations facing unique barriers in accessing care, identifying partners to enhance reach, and collaborating to help address the asthma disparities.

The long-term trends that show a decline in emergency department visits is encouraging, and reflect additional benefits for the state, as well as reduces costs and adverse impacts for individuals and families in reduced health care costs, missed days of school and work, reduced productivity and performance, and improved activity levels and overall quality of life.

How We Can Improve

The National Asthma Education and Prevention Program (NAEPP), coordinated by the National Heart, Lung, and Blood Institute (NHLBI), released its third set of clinical practice guidelines for asthma. The Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3) reflected the latest scientific advances in asthma drawn from a systematic review of the published medical literature by an NAEPP-convened expert panel. Recent updates to this 2007 guidance have been released in 2012 and 2000, to reflect the best available science in asthma care.

We can continue to:

  • strengthen provider best practices by promoting and provide trainings on guideline care standard updates;
  • organize learning collaboratives and quality improvement opportunities to increase the number of providers who implement clinical best practices, including screening and assessing for uncontrolled asthma, providing more intensive education for those with uncontrolled asthma on asthma basics, medications, proper device use, triggers, and daily management;
  • promote the collection and tracking of key asthma management indicators by health care providers, including proper device use, asthma control assessments, and hospitalizations/emergency department visits, as needed;
  • develop asthma specific discharge and follow-up guidance, including delivery and/or referrals for intensive asthma self-management education (AS-ME) for patients with asthma-related emergency department visits and hospitalizations;
  • build an Asthma Self-Management Education (AS-ME) infrastructure to expand access to and delivery modalities for better reach statewide to all individuals with uncontrolled, persistent, and high-risk asthma (e.g., school AS-ME programs, Online Self-Management Platform, referral service program) to prevent asthma-related emergency department visits and hospitalizations.
  • supply education materials and resources to asthma educators and other health professionals within the state;
  • elevate asthma as a priority issue among leadership and key partners by convening the Asthma Advisory Panel to present on emerging topics and to identify strategies for enhancing the system of care and addressing any challenges identified.
  • expand and promote partnerships, linkages and referral pathways to identify uncontrolled asthma patients earlier and refer to key support services, as needed, including for those in high burden priority populations, including the Vermont Department of Health Offices of Local Health to better reach local communities; Vermont Family and Child Health to increase coordination in schools and among school nurses to train school nurses, and support delivery of asthma self-management education; and other partners to support asthma best practices in schools, workplaces, and multi-unit housing complexes, and other settings.
  • explore reimbursement for community-based asthma education, weatherization, and home-based visiting for asthma control;
  • work with other New England States’ programs through the Asthma Regional Council to explore collaboration, trainings, and other resources to the benefit of Vermonters;
  • increase awareness among the public and provide resources for individuals and families impacted by asthma through focused media campaigns and updated webpages, including creating digital media campaigns to increase awareness of risks of tobacco use/vaping and secondhand smoke exposures, increasing referrals to 802Quits, promoting importance of flu shots and asthma action plans, and reducing exposures to asthma triggers in homes and schools;
  • develop tailored communications to expand awareness of best practices and access to care through translated materials and resources, accessible communications, age-appropriate tools and resources, etc.;
  • continue working closely with the Vermont Asthma Program works closely with Vermont surveillance experts and evaluation partners to ensure data-driven decision-making and quality programming to direct resources for the greatest impact where there is the highest burden of asthma.

These various strategies, among others, will help support our efforts to further reduce asthma-related emergency department visits and hospitalizations.  In most cases people should not have to go to an emergency department, or be admitted into a hospital, if they have properly controlled and managed asthma.

Notes on Methodology

Data source: Vermont Uniform Hospital Discharge Data Set (VUHDDS)

  • This indicator presents the rate of Vermont residents under the age of 5 who report at a hospital in Vermont, New Hampshire or Massachusetts but who are not admitted to a hospital as a result of their visit.  Rate here are only for primary diagnoses of asthma and do not include visits where asthma was noted as an underlying (or secondary, tertiary, etc.) cause.
  • Rates are calculated by dividing the number of discharges in a calendar year by the Vermont population in the same time period and multiplying by 10,000.
  • The target rate of 25 we aim to work toward was identified based on more than a decade of program interventions and reflects a reasonable, but not overly ambitious target; given the complex factors that contribute to poor asthma control, including for example, older housing stock. Reaching the target would indicate a statistically significant positive change.

Data is updated as it becomes available, usually on an annual basis.

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