Implementing Pediatric Asthma Pathways in Community Hospitals: A National Qualitative Study

Area of Science:

• Healthcare Management
• Pediatric Quality Improvement
• Implementation Science

Background:

• Asthma pathways can enhance pediatric care quality but successful implementation across diverse settings remains poorly understood.
• Previous research focused on clinical effectiveness, primarily in children's hospitals, leaving gaps for community hospital settings.
• Community hospitals treat the majority of children with asthma nationally, highlighting the need for implementation research in these environments.

Purpose of the Study:

• To identify key determinants for successful pediatric asthma pathway implementation in community hospitals.

Main Methods:

• A qualitative study involving healthcare providers leading implementation projects in a national collaborative.
• Data collection through semi-structured discussions between project leaders and external facilitators (EFs) from December 2017 to April 2018.
• Inductive thematic analysis to identify key themes and determinants of pathway implementation.

Main Results:

• Thirty-two project leaders from 18 hospitals participated.
• Key determinants included: building implementation infrastructure (teams, workflows, training), engaging providers (buy-in, collaboration, conflict resolution), addressing organizational/resource limitations (EMR integration), and co-developing solutions with EFs.

Conclusions:

• Identified determinants can guide pediatric quality improvement efforts in community hospitals.
• External facilitators (EFs) play a significant role in successful pathway implementation within community settings.