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Multicenter analysis of quality indicators for children treated in the emergency department for asthma
Marion R Sills1, Adit A Ginde, Sunday Clark
1Department Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
This study found no significant link between emergency department asthma care processes and patient outcomes in children. Outpatient care may be more influential for successful asthma management.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Asthma Management
Background:
- Acute asthma exacerbations are a common reason for pediatric emergency department visits.
- Assessing the quality of emergency care for pediatric asthma is crucial for improving patient outcomes.
- Existing research has explored process-outcome associations, but findings in pediatric emergency settings require further investigation.
Purpose of the Study:
- To investigate the association between process and outcome measures of acute asthma care quality in children treated in emergency departments.
- To determine if adherence to national asthma guidelines in emergency care predicts successful discharge or admission rates.
- To evaluate the relationship between specific process measures (receipt of care, timeliness) and key outcomes in pediatric asthma patients.
Main Methods:
- A prospective, multicenter study enrolled 1426 children (2-17 years) with acute asthma in 14 US emergency departments.
- Investigators analyzed the association between 7 guideline-concordant process measures and 2 outcome measures (successful discharge, admission).
- Statistical models were adjusted for variables known to influence acute asthma care quality.
Main Results:
- Successful discharge occurred in 62% of patients; 24% were admitted.
- The composite score for receipt of 5 process measures was 84%. Timeliness scores were 57% for corticosteroids and 92% for beta-agonists.
- No significant association was found between most process measures and outcomes. Timely beta-agonist administration was linked to admission, likely due to confounding by asthma severity.
Conclusions:
- No clinically significant association exists between process and outcome quality measures for pediatric asthma care in emergency departments.
- Emergency department care quality did not predict successful discharge, suggesting other factors are more influential.
- Outpatient care and other non-emergency department factors may play a more critical role in determining successful outcomes for pediatric asthma patients.
Objective:
To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.
Methods:
Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.
Results:
In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely β-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely β-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association.
Conclusions:
We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.
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