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Effectiveness of Pediatric Asthma Pathways for Hospitalized Children: A Multicenter, National Analysis
Sunitha V Kaiser1, Jonathan Rodean2, Arpi Bekmezian1
1Department of Pediatrics, University of California, San Francisco, CA.
Insights
Implementing clinical pathways for pediatric asthma hospitalizations reduced length of stay and costs. These pathways also decreased antibiotic use without impacting readmission rates, improving overall care value.
Area of Science:
- Pediatric hospital medicine
- Health services research
- Clinical informatics
Background:
- Asthma is a common pediatric respiratory illness requiring hospitalization.
- Clinical pathways aim to standardize care and improve outcomes for hospitalized children.
- The impact of pediatric asthma clinical pathways on care delivery and patient outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of inpatient pediatric asthma clinical pathway implementation on healthcare utilization and patient outcomes.
- To determine if clinical pathways influence length of stay, readmission rates, and medication/diagnostic test utilization for pediatric asthma patients.
Main Methods:
- Retrospective, multicenter cohort study utilizing the Pediatric Health Information System database (2006-2015).
- Analysis of data from 42 children's hospitals, assessing pathway implementation impact on children aged 2-17 years admitted for asthma.
- Interrupted time series analysis using generalized estimating equations to assess associations between pathway implementation and outcomes, risk-adjusted for patient and hospital characteristics.
Main Results:
- Clinical pathway implementation correlated with an 8.8% reduction in length of stay and a 3.1% decrease in hospital costs.
- Pathway use was associated with increased odds of bronchodilator administration and decreased odds of antibiotic administration.
- No significant associations were found between pathway implementation and systemic steroid use, prolonged ipratropium administration, chest radiograph utilization, or 30-day readmission rates.
Conclusions:
- Pediatric asthma clinical pathways can effectively reduce length of stay, hospital costs, and unnecessary antibiotic prescribing.
- The implementation of these pathways does not appear to increase 30-day readmission rates for pediatric asthma patients.
- Clinical pathways represent a valuable tool for enhancing the value of care delivered to hospitalized children with asthma.
Objective:
To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study.
Study Design:
This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics.
Results:
Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission.
Conclusions:
Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.
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