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Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis
Kavita Parikh1, Susan Keller2, Shawn Ralston3
1Division of Hospital Medicine, Children's National Health System and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; kparikh@childrensnational.org.
Pediatrics
|April 7, 2018
Summary
Pediatric asthma quality improvement (QI) initiatives show no significant impact on healthcare reutilization within 30 days. Multimodal interventions, however, demonstrated positive effects on readmission rates over longer periods.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Health Services Research
Background:
- Despite evidence-based guidelines, pediatric asthma management leads to high healthcare utilization.
- Quality improvement (QI) strategies are crucial for optimizing care and reducing healthcare burdens.
Purpose of the Study:
- To systematically review inpatient asthma QI literature.
- To synthesize the impact of QI interventions on subsequent healthcare utilization in pediatric asthma patients.
Main Methods:
- Systematic review of Medline and CINAHL databases (1991-2016).
- Inclusion of English-language, inpatient-initiated asthma QI studies.
- Random-effects models used to calculate pooled risk ratios for healthcare utilization outcomes.
Main Results:
- Twelve studies provided reutilization data; no significant impact on emergency department revisits or readmissions within 30 days.
- Risk ratios for readmissions between 30 days and 1 year ranged from 1.27 to 1.68.
- Multimodal interventions showed reduced readmission rates (RR: 1.49) over 30 days to 1 year.
Conclusions:
- No inpatient QI strategies were identified that reduced healthcare reutilization within 30 days.
- Multimodal QI interventions show promise for reducing pediatric asthma readmissions over longer time intervals.
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