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Implementing pediatric inpatient asthma pathways.

Nisha Gupta1, Adithya Cattamanchi2, Michael D Cabana1,3

  • 1Department of Pediatrics, University of California, San Francisco, CA, USA.

The Journal of Asthma : Official Journal of the Association for the Care of Asthma
|March 12, 2020
PubMed
Summary
This summary is machine-generated.

Hospitals successfully adopted and implemented pediatric asthma pathways with high fidelity. However, challenges with electronic health records (EHRs) may have limited pathway reach for hospitalized children.

Keywords:
Asthmachildclinical pathwayquality improvement

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Area of Science:

  • Pediatric Hospital Medicine
  • Healthcare Quality Improvement
  • Clinical Pathways

Background:

  • Evidence-based guidelines, known as pathways, improve care for hospitalized children with asthma.
  • Limited data exist on factors influencing pathway implementation by hospital leaders and clinicians.

Purpose of the Study:

  • To evaluate the adoption, implementation, and reach of inpatient pediatric asthma pathways.
  • To identify facilitators and barriers to pathway implementation in a national collaborative.

Main Methods:

  • Mixed-methods study involving 85 hospitals in a national collaborative.
  • Data collected via electronic surveys, field observations, and chart reviews of children (2-17 years) with asthma.
  • Quantitative analysis used descriptive statistics and multivariable regression; qualitative analysis used thematic content analysis.

Main Results:

  • 68 out of 85 (80%) hospitals adopted and completed the collaborative.
  • High fidelity implementation of pathways was observed, with a median of 5 out of 5 core components implemented.
  • Median implementation time was 5 months, with a median time cost of 78 hours. Barriers included modifying electronic health records (EHRs), with only 63% of children having electronic pathway orders.

Conclusions:

  • Hospitals demonstrated high fidelity in implementing pediatric asthma pathways.
  • Electronic health record (EHR) modification challenges may have restricted the reach of pathways to eligible children.