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Effectiveness of Pediatric Asthma Pathways in Community Hospitals: A Multisite Quality Improvement Study
Mansi Desai1, Katherine Caldwell1, Nisha Gupta1
1Department of Pediatrics, University of California, San Francisco, California.
Insights
Implementing clinical pathways improved pediatric asthma care in community hospitals. Key improvements included timely corticosteroid use and secondhand smoke screening, with reduced imaging and antibiotic use.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Clinical Pathways
Background:
- Clinical pathways enhance evidence-based care for specific conditions.
- Previous studies demonstrated pathway benefits primarily in tertiary pediatric hospitals.
- This study aimed to improve pediatric asthma care quality in community hospital settings.
Purpose of the Study:
- To implement and evaluate the impact of clinical pathways on pediatric asthma care quality across multiple measures in community hospitals.
- To assess changes in emergency department (ED) and inpatient care processes and outcomes following pathway implementation.
Main Methods:
- A quality improvement study involving children aged 2-17 with asthma in two community hospitals.
- Data collected pre- and post-pathway implementation over 28 months, utilizing local champions, education, audit/feedback, and EHR integration.
- Key performance measures included ED triage severity assessment, timely corticosteroid administration, chest radiograph (CXR) use, hospital admission, length of stay (LOS), secondhand smoke screening, and antibiotic prescribing, analyzed via statistical process control.
Main Results:
- Pathway implementation was associated with increased timely systemic corticosteroid administration (e.g., Site 1: 32% to 57%) and secondhand smoke screening (e.g., Site 1: 82% to 100%).
- Significant reductions observed in CXR utilization (Site 1: 44% to 29%), ED LOS (Site 1: 230 to 197 minutes), and antibiotic prescriptions (Site 2: 23% to 3%).
- No significant changes noted in other measured outcomes.
Conclusions:
- Clinical pathways effectively improved the quality of pediatric asthma care within community hospital ED and inpatient settings.
- The findings support the broader adoption of clinical pathways to standardize and enhance pediatric asthma management in diverse healthcare environments.
Abstract:
Pathways guide clinicians through evidence-based care of specific conditions. Pathways have been demonstrated to improve pediatric asthma care, but mainly in studies at tertiary children's hospitals. Our global aim was to enhance the quality of asthma care across multiple measures by implementing pathways in community hospitals.
Methods:
This quality improvement study included children ages 2-17 years with a primary diagnosis of asthma. Data were collected before and after pathway implementation (total 28 mo). Pathway implementation involved local champions, educational meetings, audit/feedback, and electronic health record integration. Emergency department (ED) measures included severity assessment at triage, timely systemic corticosteroid administration (within 60 mins), chest radiograph (CXR) utilization, hospital admission, and length of stay (LOS). Inpatient measures included screening for secondhand tobacco and referral to cessation resources, early administration of bronchodilator via metered-dose inhaler, antibiotic prescription, LOS, and 7-day readmission/ED revisit. Analyses were done using statistical process control.
Results:
We analyzed 881 ED visits and 138 hospitalizations from 2 community hospitals. Pathways were associated with increases in the proportion of children with timely systemic corticosteroid administration (Site 1: 32%-57%, Site 2: 62%-75%) and screening for secondhand tobacco (Site 1: 82%-100%, Site 2: 54%-89%); and decreases in CXR utilization (Site 1: 44%-29%), ED LOS (Site 1: 230-197 mins), and antibiotic prescription (Site 2: 23%-3%). There were no significant changes in other outcomes.
Conclusions:
Pathways improved pediatric asthma care quality in the ED and inpatient settings of community hospitals.
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