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Effectiveness of paediatric asthma clinical pathways: a narrative systematic review
Kee-Hsin Chen1, Chiehfeng Cliff Chen, Hsueh-Erh Liu
1Department of Nursing, Wan Fang Hospital, Taipei Medical University , Taipei , Taiwan .
Insights
Clinical pathways (CPs) for pediatric asthma may shorten hospital stays but do not reduce readmissions or costs. More research is needed to confirm benefits and assess implementation workload for CPs in pediatric asthma care.
Area of Science:
- Pediatric pulmonology
- Healthcare management
- Evidence-based medicine
Background:
- Clinical pathways (CPs) are standardized care plans aimed at improving patient outcomes and resource utilization.
- Asthma is a common chronic respiratory condition in children, necessitating effective management strategies within healthcare settings.
Purpose of the Study:
- To systematically review the effectiveness of clinical pathways (CPs) for pediatric asthma.
- To evaluate the impact of CPs on length of hospital stay, readmissions, hospital costs, and implementation workload.
Main Methods:
- A systematic review was conducted, including randomized controlled trials, controlled clinical trials, and controlled before-and-after studies.
- Studies involving children (≤18 years) with asthma treated in hospital or emergency departments were eligible.
- Data extraction and risk of bias assessment were performed independently by two reviewers; a narrative synthesis was employed due to study heterogeneity.
Main Results:
- Seven studies with 2600 participants met the inclusion criteria.
- Clinical pathways (CPs) showed a potential to decrease the length of hospital stay for pediatric asthma patients.
- No significant reduction in additional asthma-related visits or hospital costs was observed; manpower and workload data were not available.
Conclusions:
- Current evidence suggests that pediatric asthma clinical pathways (CPs) may reduce hospital length of stay.
- Insufficient evidence exists regarding the impact of CPs on total costs and readmissions to support widespread adoption.
- Further high-quality, large randomized controlled trials are necessary to comprehensively evaluate the effectiveness and cost-efficiency of asthma CPs in pediatric inpatient care.
Objective:
To evaluate the effectiveness of clinical pathways (CPs) for paediatric asthma on length of hospital stay, additional visits due to asthma exacerbations, hospital cost, manpower and workload required for implementing CPs.
Methods:
Studies were eligible if they met the following criteria: children (≦18 years) with asthma, hospital or emergency department based, and study designs were (1) randomised controlled trial, (2) controlled clinical trial or (3) controlled before and after study. Two reviewers independently screened references, extracted data and assessed the risk of bias. We resolved disagreement by discussion between authors. Due to an insufficient number of studies and the heterogeneity of interventions and outcomes, we conducted a narrative systematic review with forest plots but did not pool results.
Results:
About 3155 relevant articles were identified through a literature search, 628 were duplicates removed, 2037 were excluded based on review of titles and abstracts and 117 were excluded because they did not meet inclusion criteria. Seven studies involving 2600 participants met the inclusion criteria. Using asthma CPs may decrease the length of hospital stay; however, CPs did not appear to reduce additional visits due to asthma exacerbations or reduce hospital costs. No eligible studies were found that quantified the manpower and workload for implementing CPs.
Conclusions:
Current studies suggest CPs may reduce the length of hospital stay, but insufficient evidence is available on total costs or readmissions to justify extensive uptake of asthma CPs in paediatric inpatient care. Higher quality, large randomised controlled trials are required that measure costs and a wider range of outcomes.
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