FAQs - About Asthma Emergency Department Visits and Hospitalizations

About Asthma Emergency Department Visits and Hospitalizations

Asthma Emergency Department (ED) data are generated from two databases within the Statewide Planning and Research Cooperative System (SPARCS): the (1) Hospital Inpatient database and (2) Outpatient database were used to create county-specific asthma ED visit rates organized by regions within New York State. The SPARCS Hospital Inpatient database collects information on all hospital discharges from acute care and rehabilitation hospitals located in New York State. This database includes records for patients who are admitted to the hospital directly from the ED and for those who are hospitalized without first utilizing the ED. The SPARCS Hospital Outpatient database contains information on ED visits for individuals who visit the ED but are not hospitalized.

The National Center for Health Statistics developed the 10th revision for the International Classification of Diseases that went into effect October 1st, 2015. Prior to October 2015, for the SPARCS Hospital Inpatient database, an asthma ED visit was defined as having been admitted to the hospital directly from the ED and having an admitting diagnosis with asthma (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 493). For the SPARCS Outpatient database, an asthma ED visit was defined as having a principal diagnosis with asthma (ICD-9-CM code of 493).

After October 2015, an asthma ED visit was defined as having been admitted to the hospital directly from the ED and having an admitting diagnosis with asthma (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code of J45). For the SPARCS Outpatient database, an asthma ED visit was defined as having a principal diagnosis with asthma (ICD-10-CM code of J45). 2016 is the first complete year of data with the ICD-10-CM definition and will serve as the new baseline going forward.

Hospital discharge data from SPARCS were used to create county-specific asthma hospital discharge rates organized by regions within New York State. Prior to October 2015, asthma hospital discharges were selected if the principal diagnosis was asthma (ICD-9-CM code of 493). After October 2015, asthma hospital discharges were selected if the principal diagnosis was asthma (ICD-10-CM code of J45). 2016 is the first complete year of data with the ICD-10-CM definition and will serve as the new baseline going forward. Population estimates used for computing the hospital discharge rates were obtained by the NYSDOH Bureau of Biometrics from the U.S. Census Bureau. Asthma hospital discharge data are presented by various age groups and by total population. Asthma hospital discharges are based on the patient's county of residence.

Population estimates used for computing the asthma ED visit rates were obtained by the New York State Department of Health (NYSDOH) Bureau of Biometrics from the United States (U.S.) Census Bureau. Asthma ED data are presented by various age groups and by total population. Asthma ED visits are based on the patient's county of residence.

Asthma ED visit data are presented as tables and maps at the state and county level. Tables include, for each county, the number of asthma ED visits for 2016 and the annual crude asthma ED visit rates per 10,000 population for age-specific groups. For the total population, crude and age-adjusted ED visits rates are presented. The age-adjusted asthma ED visit rates were calculated using the 2000 U.S. Standard Population.

Asthma hospital discharge data are presented as tables and maps at the state and county level. Tables display the latest available asthma hospital discharge data for 2016. Tables include, for each county, the number of asthma hospital discharges for 2016 and the annual crude asthma hospital discharge rate per 10,000 population age-specific groups. For the total population, crude and age-adjusted hospital discharge rates are presented. The age-adjusted asthma hospital discharge rates were calculated using the 2000 U.S. Standard Population.

About Asthma Hospital Discharges and Discharge Rates

Hospital discharge data from SPARCS were used to create county-specific asthma hospital discharge rates organized by regions within New York State. Asthma hospital discharges were selected if the principal diagnosis was asthma (ICD-9-CM code of 493). Population estimates used for computing the hospital discharge rates were obtained by the NYSDOH Bureau of Biometrics from the U.S. Census Bureau. Asthma hospital discharge data are presented by various age groups and by total population. Asthma hospital discharges are based on the patient's county of residence.

Asthma hospital discharge data are presented as tables, maps and graphs at the state and county level. Tables display the latest available asthma hospital discharge data for a three-year time period. Tables include, for each county, the number of asthma hospital discharges for each of the three years, the total number of asthma hospital discharges for the three-year period, the average population of the three-year period and the three-year average annual crude asthma hospital discharge rate per 10,000 population age-specific groups. For the total population, crude and age-adjusted hospital discharge rates are presented. The asthma hospital discharge rate was calculated by dividing the total number of asthma hospital discharges for the three-year period by three to get the average number of asthma hospital discharges per year. The average number of asthma hospital discharges was then divided by the average population of the three-year period and multiplied by 10,000. The age-adjusted asthma hospital discharge rates were calculated using the 2000 U.S. Standard Population.

Within the table data, each county is linked to that specific county's ten-year trend data. The trend data for each county is presented by a graph and table with single year and three-year average asthma hospital discharge rates. Also included, for comparison, are ten years of asthma hospital discharge rates for New York City (if that county resides within New York City) or asthma hospital discharge rates for Upstate New York (if that county resides within Upstate New York).

County three-year average asthma hospital discharge rates for each age group are also presented. A bar graph plots age-specific county asthma hospital discharge rates for eight regions and the New York State total. The New York State map displays age-specific county asthma hospital discharge rates by quartile.

What is SPARCS?

New York State maintains a statewide comprehensive data reporting system called the Statewide Planning and Research Cooperative System or SPARCS as a result of cooperation between the health care industry and government. SPARCS was initially created to collect information on discharges from hospitals, and currently collects patient level detail on patient characteristics, diagnoses and treatments, services, and charges for every hospital discharge, ambulatory surgery patient, and emergency department admission in New York State.

The SPARCS data system includes inpatient and outpatient [Ambulatory Surgery (AS) and Emergency Department (ED)] information. The regulations require that inpatient data be submitted by all Article 28 facilities certified for inpatient care and that outpatient data be submitted by all hospital-based ambulatory surgery services and all other facilities providing ambulatory surgery services. Each year approximately 2.5 million inpatient visits, over 7 million outpatient visits and more than six million ED outpatient visits in New York State are reported to SPARCS. The database contains over 120 data elements describing the patient, hospital, health care provider and hospital stay.

SPARCS continues to be a major management tool assisting hospitals, agencies, and health care organizations with decision making regarding financial planning and monitoring of inpatient and ambulatory surgery services and costs.

SPARCS is more useful for the surveillance of some diseases than for others because it includes only instances of disease and injury serious enough to require an ED visit or a hospital stay of at least 24 hours. Furthermore, the SPARCS data used here display the number of ED visits rather than the number of people who visited the EDs, which may result in inflated numbers because a person may have several ED visits for the same condition.

What are important issues for using asthma ED visit data to assess possible asthma-related problems?

Asthma is one of the leading chronic diseases of the lungs. ED visits for asthma are not only related to exposure to factors that trigger asthma episodes (see Asthma Triggers ), but also are related to access to primary care and quality of primary care. Good quality primary care that emphasizes treatment leading to effective management of the disease on a long-term basis may reduce the number of severe asthma episodes that require an ED visit. Therefore, it is important to monitor ED visits for asthma to assess the burden of the disease as well as to monitor the effectiveness of the health care system. ED visit rates for asthma vary widely among communities.

What are important issues for using asthma hospital discharge data to assess possible asthma-related problems?

People who are hospitalized with asthma represent only a small proportion of people who have asthma, because hospitalizations are people whose condition was serious enough to require a hospital stay.

Asthma hospitalizations are the result of exposure to factors that trigger asthma episodes (see Asthma Triggers )as well as access to quality primary care. Good quality primary care that emphasizes treatment leading to effective management of the disease on a long-term basis may reduce the number of severe asthma episodes that requires a hospitalization. Therefore, it is important to monitor hospitalizations for asthma to assess the burden of the disease as well as to monitor the effectiveness of health care system.

Why are small numbers of cases or events a concern when looking at health data?

Questions about diseases and conditions such as asthma often lead to looking at the disease in small geographic areas such as neighborhoods and ZIP Codes. When the focus is on small areas, the number of health events is likely to be small. When dealing with small numbers of health events, privacy and confidentiality need to be maintained. In addition, people need to be aware that seemingly small changes in the number of events can dramatically change calculated rates.

Data should not be released in a way that may identify a person or release confidential information about that person.

In the tables of asthma ED visits or hospitalizations by County, the number is not shown if it is less than six. A count of no ED visits or no hospitalizations is shown in the tables because a count of zero is not a threat to confidentiality.

In an area with a small number of health events per year, an increase or decrease of just one or two events per year can cause the ED visit or hospitalization rate to change dramatically from year to year; such a rate is likely to be unstable.

In an area with a large number of health events each year, small increases or decreases in the number of events have little effect on the ED visit or hospitalization rate (stable rate). (For additional information on this issue and the relative standard error [RSE], see Rates Based Small Numbers).

In the tables, rates based on ten or fewer ED visits (RSE 30%) are considered unstable and are marked with an asterisk. These rates should be interpreted with caution.

Why are the asthma ED visit rates and hospitalization rates generated by multiple age groupings?

Health data are often generated by age groups to identify possible high-risk groups, as well as to provide information that is comparable to that from other states and to national goals and objectives.The reasons for including the age groupings in the tables of asthma events are as follows:

Age Groups Description
0-4 years Common age break for pediatric asthma; Healthy People 2020 age grouping for asthma ED visits; age grouping used by the U.S. Centers for Disease Control and Prevention (CDC) in Surveillance for Asthma - United States, 1980-1999
0-17 years Age break used for tracking asthma objectives for NYSDOH's health plan (Communities Working Together for a Healthier New York)
18-64 years Age group representing the working adult population; with the 0-17 year and 65+ year age groups, provide the complete age distribution of asthma ED visits and allows for the calculation of age-adjusted rates.
65+ years Healthy People 2020 age grouping for asthma ED visits
5-11 years
12-17 years
18-24 years
25-44 years
45-64 years
These age groups are common age groups that are used by the National Asthma Guidelines, policy makers, health care professionals, researchers as well as the general public.

More information and links can be found at NYSDOH's Asthma Information.