Pathways to Improve Pediatric Asthma Care: A Multisite, National Study of Emergency Department Asthma Pathway Implementation - 22/07/20
, Michael D. Johnson, MD, MS 2, 3, Theresa A. Walls, MD, MPH 4, 5, Stephen J. Teach, MD, MPH 6, Esther M. Sampayo, MD, MPH 7, 8, Nanette C. Dudley, MD 2, 3, Joseph J. Zorc, MD, MSCE 4, 5Abstract |
Objective |
To determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs).
Study design |
In this quality improvement study, a national sample of EDs were provided pathways to tailor to local needs. Implementation strategies included local champions, external facilitators/mentors, educational seminars, and audit and feedback. Outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay (balancing). Each month, EDs reviewed all charts (to a maximum of 20) of children ages 2-17 years with a primary diagnosis of asthma. Analyses were done using multilevel regression models with an interrupted time-series approach, adjusting for patient characteristics.
Results |
We enrolled 83 EDs (37 in children's hospitals, 46 in community hospitals) and 61 (73%) completed the study (n = 22 963 visits). Pathway implementation was associated with significantly increased odds of systemic corticosteroid administration within 60 minutes of arrival (aOR, 1.26; 95% CI, 1.02-1.55), increased odds of severity assessment at triage (aOR, 1.88; 95% CI, 1.22-2.90), and decreased rate of change in odds of hospital admission/transfer (aOR, 0.97; 95% CI, 0.95-0.99). Pathway implementation was not associated with chest radiograph use or ED length of stay.
Conclusions |
Pathway implementation was associated with improved quality of care for children with asthma in a diverse, national group of EDs.
Le texte complet de cet article est disponible en PDF.Abbreviations : AAP, CXR, ED, EHR, ITS, LOS, QI
Plan
| S.K. receives support from a career development grant from the Agency for Healthcare Research and Quality (K08HS024592), but this agency played no role in the study design, data collection, analysis, writing of the manuscript, or decision to submit for publication. The authors declare no conflicts of interest. |
|
| Portions of this study were presented as an abstract at the Pediatric Academic Societies annual meeting, April 24-May 1, 2019, Baltimore, Maryland. |
Vol 223
P. 100 - août 2020 Retour au numéro
Article précédent
- 50 Years Ago in The Journal of Pediatrics : Change in Growth Hormone with Obesity: More Consequence Than Cause, Although Questions Remain
- Connor Corcoran, Diane E.J. Stafford, David M. Maahs
- 50 Years Ago in The Journal of Pediatrics : Clinical and Genetic Delineation of Saethre–Chotzen Syndrome
- Philip F. Giampietro
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?