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Impact of a National Quality Collaborative on Pediatric Asthma Care Quality by Insurance Status
Sarah B Schechter1, Matthew S Pantell2, Kavita Parikh3
1Department of Pediatrics, University of California, San Francisco (SB Schechter, MS Pantell, and SV Kaiser).
Insights
Children with public insurance had higher asthma care utilization but the national quality improvement collaborative did not reduce disparities. Further research is needed to address these inequities in pediatric asthma outcomes.
Area of Science:
- Pediatric asthma care
- Health services research
- Quality improvement initiatives
Background:
- Disparities in healthcare access and outcomes exist based on insurance type.
- Asthma management in emergency departments (ED) and inpatient settings can be standardized.
- Quality improvement (QI) collaboratives aim to reduce variations in care and improve patient outcomes.
Purpose of the Study:
- To evaluate pre-existing disparities in pediatric asthma care and outcomes between children with public versus private insurance.
- To determine the impact of the Pathways for Improving Pediatric Asthma Care (PIPA) QI collaborative on these disparities.
Main Methods:
- Secondary analysis of data from the PIPA national collaborative.
- Inclusion of children aged 2-17 with asthma diagnosis.
- Examination of disparities based on insurance status (public vs. private) before and after the QI collaborative.
- Assessment of guideline adherence and healthcare utilization measures.
Main Results:
- At baseline, children with public insurance received more early corticosteroid administration but had higher rates of admission, longer inpatient stays, and more frequent 30-day readmissions/ED revisits compared to those with private insurance.
- The PIPA collaborative did not lead to significant changes in guideline adherence or healthcare utilization across different insurance groups.
- Pre-existing disparities in asthma outcomes persisted despite the QI initiative.
Conclusions:
- Children with public insurance experienced higher asthma-related healthcare utilization, even with more evidence-based care at baseline.
- The PIPA collaborative was ineffective in mitigating existing disparities in pediatric asthma care and outcomes.
- Future QI efforts must focus on strategies that specifically target and reduce health inequities in asthma management.
Objective:
To assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities.
Methods:
Secondary analysis of data from Pathways for Improving Pediatric Asthma Care (PIPA), a national collaborative to standardize emergency department (ED) and inpatient asthma management. PIPA included children aged 2 to 17 with a diagnosis of asthma. Disparities were examined based on insurance status (public vs private). Outcomes included guideline adherence and health care utilization measures, assessed for 12 months before and 15 months after the start of PIPA.
Results:
We analyzed 19,204 ED visits and 11,119 hospitalizations from 89 sites. At baseline, children with public insurance were more likely than those with private insurance to receive early administration of corticosteroids (52.3% vs 48.9%, P= .01). However, they were more likely to be admitted (20.0% vs 19.4%, P = .01), have longer inpatient length of stay (31 vs 29 hours, P = .01), and have a readmission/ED revisit within 30 days (7.4% vs 5.6%, P = .02). We assessed the effects of PIPA on these disparities by insurance status and found no significant changes across 6 guideline adherence and 4 health care utilization measures.
Conclusion:
At baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care. The PIPA collaborative did not affect pre-existing disparities in asthma outcomes. Future research should identify effective strategies for leveraging QI to better address disparities.
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