Preventing Chronic Disease | Defining Emergency Department Asthma Visits for Public Health Surveillance, North Carolina, 2008–2009 - CDC
Defining Emergency Department Asthma Visits for Public Health Surveillance, North Carolina, 2008–2009
Debbie Travers, PhD; Kristen Hassmiller Lich, PhD; Steven J. Lippmann, MSPH; Morris Weinberger, PhD; Karin B. Yeatts, PhD; Winston Liao, MPH; Anna Waller, ScD
Suggested citation for this article: Travers D, Lich KH, Lippmann SJ, Weinberger M, Yeatts KB, Liao W, et al. Defining Emergency Department Asthma Visits for Public Health Surveillance, North Carolina, 2008–2009. Prev Chronic Dis 2014;11:130329. DOI:http://dx.doi.org/10.5888/pcd11.130329
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Abstract
Introduction
When using emergency department (ED) data sets for public health surveillance, a standard approach is needed to define visits attributable to asthma. Asthma can be the first (primary) or a subsequent (2nd through 11th) diagnosis. Our study objective was to develop a definition of ED visits attributable to asthma for public health surveillance. We evaluated the effect of including visits with an asthma diagnosis in primary-only versus subsequent positions.
When using emergency department (ED) data sets for public health surveillance, a standard approach is needed to define visits attributable to asthma. Asthma can be the first (primary) or a subsequent (2nd through 11th) diagnosis. Our study objective was to develop a definition of ED visits attributable to asthma for public health surveillance. We evaluated the effect of including visits with an asthma diagnosis in primary-only versus subsequent positions.
Methods
The study was a cross-sectional analysis of population-level ED surveillance data. Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008–2009, we used data from the 111 (97%) that participated during those years. Included were all ED visits with an ICD-9-CM diagnosis code for asthma in any diagnosis position (1 through 11). We formed 11 strata based on the diagnosis position of asthma and described common chief complaint and primary diagnosis categories for each. Prevalence ratios compared each category’s proportion of visits that received either asthma- or cardiac-related procedure codes.
The study was a cross-sectional analysis of population-level ED surveillance data. Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008–2009, we used data from the 111 (97%) that participated during those years. Included were all ED visits with an ICD-9-CM diagnosis code for asthma in any diagnosis position (1 through 11). We formed 11 strata based on the diagnosis position of asthma and described common chief complaint and primary diagnosis categories for each. Prevalence ratios compared each category’s proportion of visits that received either asthma- or cardiac-related procedure codes.
Results
Respiratory diagnoses were most common in records of ED visits in which asthma was the first or second diagnosis, while primary diagnoses of injury and heart disease were more common when asthma appeared in positions 3–11. Asthma-related chief complaints and procedures were most common when asthma was the first or second diagnosis, whereas cardiac procedures were more common in records with asthma in positions 3–11.
Respiratory diagnoses were most common in records of ED visits in which asthma was the first or second diagnosis, while primary diagnoses of injury and heart disease were more common when asthma appeared in positions 3–11. Asthma-related chief complaints and procedures were most common when asthma was the first or second diagnosis, whereas cardiac procedures were more common in records with asthma in positions 3–11.
Conclusion
ED visits should be defined as asthma-related when asthma is in the first or second diagnosis position.
ED visits should be defined as asthma-related when asthma is in the first or second diagnosis position.
Acknowledgments
Thanks to John Crouch for pre-processing data. State public health surveillance system (NC DETECT) data were provided by the North Carolina Public Health Data Group. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the North Carolina Public Health Data Group or NC DETECT. The authors take sole responsibility for the scientific validity and accuracy of methodology, results, statistical analyses, and conclusions presented. Mr. Lippmann’s graduate assistance work on this project was supported by a Gillings Innovation Laboratory award from the University of North Carolina Gillings School of Global Public Health. Work by Dr. Hassmiller Lich was partially supported by Award no. KL2RR025746 from the National Center for Research Resources. At the time of this study Winston Liao was affiliated with the North Carolina Division of Public Health
Author Information
Corresponding Author: Debbie Travers, School of Nursing, CB 7460, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460. Telephone: 919-966-5357. E-mail: dtravers@email.unc.edu.
Author Affiliations: Debbie Travers, Kristen Lich, Steven J. Lippmann, Karin Yeatts, Anna Waller, University of North Carolina, Chapel Hill, North Carolina; Morris Weinberger, University of North Carolina, Chapel Hill, Durham Veteran’s Affairs Medical Center, Durham, North Carolina; Winston Liao, North Carolina COPD Task Force, Cary, North Carolina.
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