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Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma
Melanie A Ruffner1, Sarah E Henrickson2, Marianne Chilutti3
1Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Implementing a proactive follow-up system in allergy departments significantly improved appointment scheduling and attendance for pediatric asthma patients. This intervention reduced hospital readmissions, enhancing care quality for children with asthma.
Area of Science:
- Pediatric Allergy and Immunology
- Quality Improvement in Healthcare
- Asthma Management
Background:
- Pediatric asthma is a significant cause of emergency department visits and hospital readmissions.
- Effective post-discharge care is crucial for managing pediatric asthma exacerbations.
Purpose of the Study:
- To implement and evaluate an allergy department-based intervention to enhance follow-up appointment scheduling for pediatric asthma patients post-discharge.
- To reduce hospital readmission rates for pediatric asthma exacerbations.
Main Methods:
- A quality improvement study conducted in a tertiary children's hospital allergy clinic.
- Intervention involved 3 telephone attempts and mailed reminders to schedule follow-up appointments within 30 days of discharge.
- Primary outcome: percentage of scheduled post-discharge follow-up appointments; secondary outcomes: attended appointments and 30-day readmission rates.
Main Results:
- The rate of scheduled follow-up appointments increased from 48.8% to 75.7% within 30 days of discharge.
- Attended allergy visits within 30 days post-discharge rose significantly from 35.5% to 53.9%.
- A significant decrease in 30-day hospital readmission rates was observed.
Conclusions:
- Minor organizational adjustments in allergy practices can substantially improve post-hospitalization follow-up rates.
- The intervention demonstrates a successful strategy for reducing asthma readmissions in pediatric patients.
- Proactive scheduling and follow-up are key to better asthma care outcomes.
Background:
Pediatric asthma is a major contributor to emergency room utilization and hospital readmission rates.
Objective:
To develop an allergy department‒based intervention to improve follow-up appointment scheduling processes for pediatric asthma patients after discharge for asthma exacerbation.
Methods:
This quality improvement study was conducted in the allergy clinic of an urban, tertiary children's hospital. Children receiving subspecialty allergy care for asthma were included into the intervention group during the intervention period. The quality improvement intervention consisted of 3 attempts by telephone to reach the family to schedule the follow-up appointment. If this was unsuccessful or if the appointment was not kept, then a reminder letter was sent to the family. The primary outcome of interest in this study was the percent of postdischarge follow-up appointments scheduled within 30 days of discharge. Secondary outcomes measured were the percent of allergy appointments attended within 30 days of discharge and the 30-day hospital readmission rate.
Results:
Demographics did not differ significantly between the intervention and baseline preintervention year. The initial baseline scheduled allergy follow-up visit rate was 48.8 ± 13.3% of patients discharged per month. This increased to an overall rate of 75.7 ± 20.1% patients scheduling allergy follow-up within 30 days of discharge during the intervention year. We also observed a significant increase in attended allergy visits 30 days postdischarge from 35.5 ± 15.6% in year 1 to 53.9 ± 25.5% during the intervention year and a significant decrease in the 30-day readmission rate on the allergy service.
Conclusion:
These data suggests that minor changes in allergy practice organization can significantly affect posthospitalization follow-up rates and decrease asthma readmission rates.
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