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Paediatric asthma clinical pathway: Impact on cost and quality of care
M S Shakirah1, A R Jamalludin2, A L Hasniah3
1Institute for Health Systems Research, National Institutes of Health, Shah Alam, Selangor, Malaysia. shakirah.ms@moh.gov.my.
Insights
A clinical pathway (CPW) for pediatric asthma reduced hospital stays for severe exacerbations. While costs were slightly higher, CPW improved asthma management and prevented readmissions, benefiting uncontrolled asthma patients.
Area of Science:
- Pediatric Asthma Management
- Healthcare Quality Improvement
- Health Economics
Background:
- Uncontrolled asthma leads to increased healthcare utilization and costs in Malaysia.
- Effective strategies are needed to manage the growing burden of asthma.
- Reducing healthcare costs associated with asthma is a key priority.
Purpose of the Study:
- To evaluate the effectiveness of a clinical pathway (CPW) for inpatient pediatric asthma.
- To determine if CPW reduces average length of stay (ALOS).
- To assess the impact of CPW on asthma management and healthcare costs.
Main Methods:
- A quasi-experimental, pre-post study design was employed.
- Paediatric patients (5-18 years) admitted for acute asthma exacerbation were recruited.
- Outcomes measured included ALOS, discharge medication, readmission rates, and treatment costs.
Main Results:
- CPW reduced ALOS by 26 hours for severe exacerbations (19.2 hours).
- More newly-diagnosed asthmatics received appropriate discharge medication in the CPW group.
- No readmissions occurred in the CPW group; mean treatment cost was slightly higher.
Conclusions:
- Clinical pathway management may benefit paediatric patients with uncontrolled asthma and severe exacerbations.
- CPW shows potential for improving asthma care and reducing hospital stay duration.
- Further research is recommended to explore CPW's impact from the emergency department onwards.
Introduction:
Uncontrolled asthma may cause an increase in healthcare utilisation, hospital admission and productivity loss. With the increasing burden of asthma in Malaysia, strategies aimed at reducing cost of care should be explored.
Objective:
This study aims to determine if a clinical pathway (CPW) for inpatient paediatric asthma would reduce average length of stay (ALOS), improve asthma management and decrease cost.
Methods:
A quasi-experimental, pre-post study was used to evaluate the CPW effectiveness. Paediatric inpatients aged 5-18 years old, admitted for acute asthma exacerbation from September 2015 to April 2016 were prospectively recruited. Data from patients admitted from January-July 2015 were used as control. CPW training was carried out in August 2015 using standardised modules. Direct admission cost from the provider's prospective was calculated. Outcomes compared were differences in ALOS, discharge medication, readmission within 28 days of discharge and cost.
Results:
ALOS is 26 hours lower in the CPW group for severe exacerbations and underlying uncontrolled asthma (19.2 hours) which is clinically significant as patients have shorter hospital stay. More newly-diagnosed intermittent asthmatics were discharged with relievers in the CPW group (p-value 0.006). None of the patients in the CPW group had readmissions (p-value 0.16). Mean treatment cost for patients in the intervention group is higher at RM843.39 (SD ±48.99, versus RM779.21 SD±44.33).
Conclusion:
This study found that management using a CPW may benefit asthmatic patients with uncontrolled asthma admitted with severe exacerbation. Further studies will be needed to explore CPW's impact on asthma management starting from the emergency department.
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