Asthma hospitalization rate per 10,000 children age 4 or younger
Story Behind the Curve
Updated: February 2023
Author: Asthma Program, Vermont Department of Health
NOTE: Since the nearest hospital for many Vermont residents is out-of-state, the approach of the Vermont Asthma Program is to report full data including Vermont residents treated in adjacent states. Due to changes in data collection and processing technologies, updated data from NY and NH has been delayed and so the most recent data available for this indicator is from 2016. This indicator will be updated when more recent data is available.
In general, in Vermont there has been a general downward trend in the rate of hospitalizations for asthma among children under 4 years of age over the past decade. The rates of hospitalizations for children under four has decreased from a high of 20.2 in 2006 to an all‐time low of 8.6 per 10,000 in 2015. This meant the Vermont Asthma Program achieved the Healthy Vermonter 2020 target of 14% and had to lower the target by half to 7.0 in 2014 to provide a new target for further reduction in hospitalizations!
Asthma hospitalizations have been declining over time with improved clinical care and patients following treatment guidelines. The decrease may be due to a program of comprehensive asthma control efforts being initiated in 2009 with support of a CDC asthma grant. The Vermont Asthma Program began to expand efforts to promote national asthma best practices, including supporting 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 protocols to reduce readmissions. Another 5-year CDC grant cycle started in 2014 allowing spread to additional regional hospitals of best practices shown to work, with new elements focusing on a learning collaborative of health care providers implementing asthma best practices and monitoring outcomes in patient care.
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).
Why Is This Important?
Hospitalizations for children are serious and disruptive. Hospitalizations can be costly to the family, and disrupt home routines. Effective management includes control of exposure to factors that trigger exacerbations including exposure to secondhand smoke, improved pharmacological management, regular visits with the child’s medical home, and patient education and support. Read more about asthma management from the National Heart, Lung, and Blood Institute.
This indicator is part of Healthy Vermonters 2020 which documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020.
Maternal and Child Health is a division in the Department of Health that works with the Vermont Asthma Program on increasing coordination at schools and among school nurses to address absenteeism and asthma education for school nurses/students, including training school nurses in selected supervisory unions throughout the state on asthma self-management.
Blueprint for Health is a partner that works with the Vermont Asthma Program on educating community health teams on asthma education and tools available to improve self-management, including Asthma Action Plans and Healthier Living Workshops that support improving asthma management.
Rutland Regional Medical Center is a partner that has worked with the Vermont Asthma Program on home visiting programs, the MAPLE hospital discharge protocol and community education.
Department of Vermont Health Access is a partner that works with the Vermont Asthma Program on reducing the burden of asthma among Medicaid-insured including exploring reimbursement for community-based education.
Vermont Department of Health Offices of Local Health are partners that work with the Vermont Asthma Program to disseminate asthma action plans and reach local communities.
Asthma Advisory Panel is a partner organization made up of a cross-section of experts in diverse fields and organizations that works with the Vermont Asthma Program on developing strategic goals and relationships.
Asthma Regional Council is a partner that works with the Vermont Asthma Program on facilitating meetings between the different New England Asthma Programs
Northeast American Lung Association is a partner that works with the Vermont Asthma Program on supplying education materials to asthma educators within the state.
University of Vermont: Pediatrics is a partner that works with the Vermont Asthma Program on expanding access and delivery of supplementary asthma self-management education to those with uncontrolled asthma and severe persistent asthma to prevent asthma-related emergency department visits and hospitalizations.
Vermont Child Health Improvement Project is a partner that has worked with the Vermont Asthma Program on implementing a learning collaborative to reinforce and expand asthma guideline care bast practice standards among health care providers.
Vermont Chronic Care Initiative is a partner that has worked with the asthma program on incorporating asthma education into their case management home visiting programs.
OneCare Vermont is a partner that works with the Vermont Asthma Program at improving care for pediatric and adult populations by hosting a learning collaborative and facilitating quality improvement projects among participating providers and practices in guideline care.
Hark Website Design, Branding & Communication is a partner that works with Vermont Asthma Program creating a digital media plan with the goal of increasing awareness of 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.
In 2007, 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) that reflected the latest scientific advances in asthma drawn from a systematic review of the published medical literature by an NAEPP-convened expert panel. It continues to describe a range of generally accepted best-practice approaches for making clinical decisions about asthma care.
Asking providers to implement the clinical practice guidelines for asthma and educating people with asthma on how to manage and control their asthma will result in lower hospital readmissions. In most cases people should not have to go to the hospital if they have properly controlled and managed asthma.
The Program supported the Rutland Regional Medical Center in their efforts to improve asthma management in the region, in particular through their evidence-informed Pediatric in home visiting program supported through the Blueprint Community Health Team. Pediatric in-home education and trigger reduction is effective at lowering hospital readmissions. People can self refer to this program or can be referred by a provider, and it is targeted to serve those with uncontrolled asthma. By seeking to reduce uncontrolled asthma, outlined below, the Program’s goal is to reduce the impact uncontrolled asthma has on the healthcare system and the hospitalization rates.
- 1 or More Unscheduled Visits for Emergency or Urgent Care
- 2 or More a Year Frequent Primary Care Office Visits for Asthma Symptoms
- 1 or More In-Patient Asthma Related Admissions
- 2 or More Refills of Rescue Inhalers
- Exceeds 2 or More Missed Days of School or Other Activities Related to Asthma
A declining rate of hospitalizations may indicate that the Health Department’s Asthma Program’s focus on promoting the new asthma national guidelines of care, supporting best practice reinforcement and expansion through learning collaboratives, piloting and expanding home visiting for asthma trigger identification and elimination, and providing resources to improve Vermonters’ self-management is working to keep their asthma under control.
The Vermont Asthma Program engages with lung health experts, partners, insurers, healthcare providers, hospitals, and schools to improve asthma control. Efforts focus on providing asthma self-management education in schools, clinics, and community settings, promoting use of Asthma Action Plans and proper use of spacers and inhalers, and assisting people to quit smoking and avoid tobacco smoke. Priorities include supporting in-home asthma education among populations with highest burden. The Asthma Program promotes other protective measures including receiving the annual flu shot, using clean burning stoves, and minimizing exposures to common triggers.
The Asthma Program is working with other New England state programs through the Asthma Regional Council to explore if there is a provider training program that all states could collaborate. Additionally, the Program has worked in partnership with Vermont's One Care to plan and implement a Learning Collaborative to provide guideline care education for quality improvement practices among providers serving those with asthma and COPD. The Vermont Asthma Program also works 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 to the Rutland Pediatric to support its home visiting program and the University of Vermont Pediatrics to enhance remote educational services.
The Asthma Program also worked with the Vermont Chronic Conditions Initiative (VCCI) to support/educate their case managers with the goal that the case managers administer an asthma control test, provide key messaging and supports for improved medication adherence. Lastly, the Asthma Program works with schools to train school nurses on asthma self-management and proper medication use so that school nurses can pass that knowledge onto those students who have missed school due to asthma.
Notes on Methodology
Data is updated as it becomes available, and timing varies by data source.
Discharge rates were calculated using the Vermont Uniform Hospital Discharge data set. Rates are calculated by dividing the number of discharges in a given time period by the Vermont population in the same time period and multiplying by 10,000.