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Improving Quality of Acute Asthma Care in US Hospitals: Changes Between 1999-2000 and 2012-2013
Kohei Hasegawa1, Yusuke Tsugawa2, Sunday Clark3
1Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Insights
Inpatient asthma care quality improved between 1999 and 2013, with greater adherence to national guidelines. This improved care was linked to shorter hospital stays for asthma patients, although variability persists across hospitals.
Area of Science:
- Pulmonary Medicine
- Healthcare Quality Improvement
- Health Services Research
Background:
- Longitudinal changes in acute asthma care quality for hospitalized patients in the U.S. are not well understood.
- Assessing adherence to national asthma guidelines over time is crucial for improving patient outcomes.
- Identifying factors influencing guideline concordance can optimize asthma management strategies.
Purpose of the Study:
- To evaluate the temporal trends in inpatient asthma care quality based on national guidelines.
- To identify hospital characteristics associated with better adherence to asthma care guidelines.
- To determine if guideline-concordant care impacts hospital length of stay (LOS) for asthma patients.
Main Methods:
- Analysis of data from two multicenter chart review studies conducted in 1999-2000 and 2012-2013.
- Inclusion of hospitalized patients aged 2 to 54 years with acute asthma.
- Assessment of guideline concordance at patient and hospital levels, and its association with hospital LOS.
Main Results:
- Inpatient asthma care demonstrated improved guideline concordance from 1999-2000 to 2012-2013 (mean composite score increased from 74 to 82).
- Significant interhospital variability in care concordance persisted, particularly in providing written action plans.
- Care fully concordant with guidelines was associated with a 14% shorter hospital LOS.
Conclusions:
- Guideline concordance for acute asthma care in hospitalized patients improved significantly between 1999 and 2013.
- Substantial variability in care quality across hospitals remains a challenge.
- Adherence to evidence-based asthma guidelines is associated with reduced hospital length of stay.
Background:
Little is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS).
Methods:
This study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS.
Results:
The analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P < .001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (-14% [95% CI, -23 to -4]; P = .009).
Conclusions:
Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.
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