Association between meeting adult acute asthma best practice tariff standard of care and 30 day and 90 day hospital readmission: nationwide cohort study.

Abstract

Objective: To assess whether meeting the NHS best practice tariff standard of care and its constituent elements for hospital admission of adults with acute asthma in England is associated with reduced 30 day and 90 day readmission to hospital.

Design: Nationwide cohort study.

Setting: Secondary care in England, based on data collected from the 2022-23 National Respiratory Audit Programme adult asthma audit, linked with data from Hospital Episode Statistics, 1 April 2022 to 30 June 2023.

Participants: 12 964 patients from 151 hospitals admitted with acute asthma to hospitals in England that took part in the National Respiratory Audit Programme and had their data entered, who were eligible for linkage with Hospital Episode Statistics data, were recorded as male or female sex, and were alive at discharge.

Main outcome measures: 30 and 90 day hospital readmission for asthma or any cause. Association between readmission and meeting best practice tariff standard of care and its constituent elements, adjusted for potential confounders and including a clustering effect for hospital.

Results: 3627 (28.0%) patients were documented as having received the best practice tariff standard of care (a respiratory specialist review within 24 hours of admission and a discharge bundle with key good practice elements). 538 (4.1%) and 1077 (8.3%) patients were readmitted to hospital with asthma within 30 and 90 days, respectively. Receiving best practice tariff standard of care was not associated with either readmission (30 day asthma readmission adjusted odds ratio 0.88 (95% confidence interval (CI) 0.71 to 1.08); 90 day adjusted odds ratio 1.01 (0.87 to 1.17)), and nor was receiving a respiratory specialist review within 24 hours of arrival (30 day adjusted odds ratio 0.92 (0.76 to 1.10); 90 day adjusted odds ratio 1.01 (0.89 to 1.16)). Receiving a discharge bundle was associated with reduced readmission (30 day adjusted odds ratio 0.61 (95% CI 0.50 to 0.75), number needed to treat 68; 90 day adjusted odds ratio 0.77 (0.65 to 0.89), number needed to treat 67), as was receiving a respiratory specialist review at any point (30 day adjusted odds ratio 0.70 (95% CI 0.55 to 0.89), number needed to treat 75). 79.5% of participants who received a respiratory specialist review received a discharge bundle (8596/10 816) compared with 19.4% of those who did not receive a specialist review (417/2148).

Conclusions: In this study, components of the adult asthma discharge bundle were associated with reduced readmission to hospital for asthma. Best practice tariffs should be evidence based to improve quality of care and patient outcomes.