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Modification of an Established Pediatric Asthma Pathway Improves Evidence-Based, Efficient Care
Lori Rutman1,2, Robert C Atkins3, Russell Migita4,2
1University of Washington, Seattle, Washington; lori.rutman@seattlechildrens.org.
Insights
Revising a pediatric asthma pathway improved evidence-based care and patient flow. This enhanced care for asthma patients was sustained for two years without increasing costs.
Area of Science:
- Pediatric Medicine
- Healthcare Management
- Clinical Pathways
Background:
- Established pediatric asthma pathways require regular evaluation to ensure optimal patient care.
- Clinical guidelines evolve, necessitating updates to existing care protocols.
- Standardization of care can improve efficiency and adherence to best practices.
Purpose of the Study:
- To assess the impact of a revised pediatric asthma pathway on adherence, evidence-based care delivery, length of stay, and costs.
- To evaluate the sustainability of improvements following pathway modification.
- To determine if pathway revisions influence provider practices and patient outcomes.
Main Methods:
- Utilized International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify pediatric asthma cases.
- Analyzed data from 24 months pre- and post-pathway modification.
- Employed statistical process control and interrupted time series analysis to evaluate process and outcome measures.
Main Results:
- Pathway adherence remained high (79%-88%) post-revision.
- Significant improvements in evidence-based care delivery were sustained for two years.
- Emergency department length of stay for asthma admissions decreased by 30 minutes (10%), with a nominal cost increase.
Conclusions:
- Modification of the pediatric asthma pathway resulted in sustained improvements in evidence-based care and patient flow.
- Continuous re-evaluation of clinical pathways can effectively drive practice changes and enhance patient care.
- The revised pathway demonstrated improved efficiency without negatively impacting healthcare costs.
Objective:
In September 2011, an established pediatric asthma pathway at a tertiary care children's hospital underwent significant revision. Modifications included simplification of the visual layout, addition of evidence-based recommendations regarding medication use, and implementation of standardized admission criteria. The objective of this study was to determine the impact of the modified asthma pathway on pathway adherence, percentage of patients receiving evidence-based care, length of stay, and cost.
Methods:
Cases were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Data were analyzed for 24 months before and after pathway modification. Statistical process control was used to examine changes in processes of care, and interrupted time series was used to examine outcome measures, including length of stay and cost in the premodification and postmodification periods.
Results:
A total of 5584 patients were included (2928 premodification; 2656 postmodification). Pathway adherence was high (79%-88%) throughout the study period. The percentage of patients receiving evidence-based care improved after pathway modification, and the results were sustained for 2 years. There was also improved efficiency, with a 30-minute (10%) decrease in emergency department length of stay for patients admitted with asthma (P = .006). There was a nominal (<10%) increase in costs of asthma care for patients in the emergency department (P = .04) and no change for those admitted to the hospital.
Conclusions:
Modification of an existing pediatric asthma pathway led to sustained improvement in provision of evidence-based care and patient flow without adversely affecting costs. Our results suggest that continuous re-evaluation of established clinical pathways can lead to changes in provider practices and improvements in patient care.
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