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. 2025 Aug 4;4(1):e001398.
doi: 10.1136/bmjmed-2025-001398. eCollection 2025.

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

Alexander Adamson  1 , James Dodd  2 , Thomas Wilkinson  3 , James M Calvert  4 , George W Nava  2 , Peter Van Geffen  5 , Jennifer K Quint  1
Affiliations

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

Alexander Adamson et al. BMJ Med. .

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.

Keywords: Asthma; Health policy; Pulmonary medicine; Quality of health care.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; AA declares an institutional grant from Royal College of Physicians for his role on the National Respiratory Audit Programme (NRAP) analysis team to support the current manuscript; JD declares a Bristol National Institute for Health and Care Research (NIHR) Biomedical Research Centre grant to institution to support the current manuscript, a GSK externally sponsored research grant to institution for the CONTENTed (Characterisation of Neuroimaging and Wellbeing over Time in Severe Eosinophilic Asthma Treated with Mepolizumab) study, an AstraZeneca and Chiesi educational research grant to institution, honoraria for lectures, presentations, educational events from AstraZeneca, GSK, PulmonX, and Chiesi, support from Sanofi and Chiesi for attending the British Thoracic Society and European Respiratory Society, respectively, participation on the data safety monitoring board for the ON PACE NIHR HTA (Optimal Nutritional Support for People with Advanced Cancer and Eating Difficulties: NIHR Health Technology Assessment) trial, and leadership or fiduciary roles in the following institutions: clinical lead adult asthma and chair research committee for NRAP, member of the respiratory clinical working group for the Health Innovation Network, member of the chronic obstructive pulmonary disease (COPD) Biologics National Pathway consortium, member of COPD and Asthma National Research Strategy groups as part of the NIHR Biomedical Research Centre Translational Research Collaboration, a Caldicott Guardian for Avon longitudinal study of parents and children (ALSPAC), a member of the steering group for the UK severe asthma registry, and deputy theme lead and WS lead for NIHR Bristol Biomedical Research Centre; TW declares an NHS grant to the Royal College of Physicians London and salary to institution to support the current manuscript, research grants from AstraZeneca, GSK, Sanofi, Johnson & Johnson, Biomerieux, Synairgen, Bergenbio, and my mhealth to institution, personal consulting fees from AstraZeneca, GSK, Janssen, Sanofi, Synairgen, mymhealth, Tidalsense, and Enanta, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Enanta, and GSK, patents filed on lung diagnostics with the University of Southampton, participation on a data safety monitoring board or advisory board for AstraZeneca, GSK, and Roche, NRAP lead, shares, and a director role in mhealth, and medical writing support from AstraZeneca; JMC declares grants for conference attendance from GSK and AstraZeneca, and assistance with medical writing from AstraZeneca for work unrelated to this manuscript; GWN declares institutional funding from GSK for a research study and direct payment of online access fees to European Respiratory Society conference 2023 from GSK; JKQ declares institutional funds in her role as the analysis lead for the NRAP to support the current manuscript, institutional grants from Medical Research Council, NIHR, Health Data Research, GSK, BI, AstraZeneca, Insmed, and Sanofi, payment or honaria from GSK, BI, Sanofi, Chiesi, and AstraZeneca, and a leadership or fiduciary role as joint edior-in-chief of Thorax; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Adjusted odds ratios for association between 30 day and 90 day readmission to hospital for asthma and receiving best practice tariff standard of care and associated elements, for adults admitted to hospital with acute asthma. The nesting structure of the elements within the best practice tariff standard of care is indicated by amount of indentation. Presented elements sometimes overlap and are not mutually adjusted for each other. Presented variables represent the association between a particular element and outcome, adjusted for age, sex, index of multiple deprivation group, smoking status, severity of asthma attack, Charlson comorbidity index, and a patient history of three or more courses of rescue or emergency oral steroid prescriptions in the 12 months before admission, with a clustering effect for hospital
Figure 2
Figure 2. Most common combinations of elements received as part of the discharge bundle for patients admitted to hospital with acute asthma. Row height is proportional to the number of patients who received that specific combination of discharge bundle elements. The smoking cessation element was not included because this element was only relevant for current smokers
See this image and copyright information in PMC

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