Improving Patient Outcomes by Addressing Provider Variation in Emergency Department Asthma Care

Asthma exacerbations are frequent in the pediatric emergency department (ED) and result in significant morbidity and costs; standardized treatment improves outcomes. In this study, we aimed to use provider adherence data and the associated patient outcomes as an intervention to change behavior and improve care.

We used a retrospective cohort design to analyze 2 years of baseline data for asthma patient encounters. Providers were classified based on guideline adherence. We compared patient outcomes by provider adherence using Mann-Whitney U and Fisher's exact test. Our intervention included education with data feedback and peer comparison. We then analyzed changes in guideline adherence, the proportion of patients admitted, length of stay (LOS), and costs for this population over time using statistical process control charts.

In our baseline data analysis, patients seen by less adherent physicians had a higher likelihood of admission (65.1% versus 50.8%, P < 0.001), a longer ED LOS (4.7 versus 4.2 h, P = 0.007), and higher costs ($1,896.20 versus $1,728.50, P < 0.001). Using SPC analysis, there was an improvement in guideline adherence by providers (64%-77%) with a mirrored improvement in patient adherence (76%-84%) associated with our interventions. Admissions decreased 1 year after the intervention; ED LOS and returns remained unchanged.

In this study, we evaluated patient outcomes according to provider adherence to a clinical guideline and used the results to change provider behavior and improve patient outcomes. Active provision of feedback with peer comparison for providers was associated with improved adherence over time.