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Quality Indicators of Pediatric Asthma Care in the Emergency Department; a Systematic Review and Meta-Analysis
Islam E Alkhazali1, Ahmad Alrawashdeh2, Mohd Hashairi Fauzi3
1School of Medical Sciences, Health Campus, USM, Kubang Kerian, 16150, Malaysia.
Insights
This review identified 129 quality indicators for pediatric asthma care in emergency departments (EDs). While many focus on process, there
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Asthma Management
Background:
- Pediatric asthma care in emergency departments (EDs) is critical.
- Existing quality indicators (QIs) for pediatric asthma in the ED require systematic identification and description.
Purpose of the Study:
- To identify and describe existing quality indicators (QIs) for pediatric asthma care in the emergency department (ED).
Main Methods:
- Systematic search of electronic databases for English-language publications on pediatric asthma QIs in the ED.
- Data extraction on study characteristics, QIs, and compliance rates.
- Classification of QIs using Donabedian and Institute of Medicine (IOM) frameworks.
- Meta-analysis of compliance rates where feasible.
- Quality assessment using Joanna Briggs Institute (JBI) tools.
Main Results:
- Twenty studies yielded 129 QIs for pediatric asthma in the ED.
- Most QIs (86.8%) focused on the process of care (Donabedian framework).
- IOM framework highlighted effectiveness and safety indicators.
- Significant variability in compliance rates for identified QIs was observed.
Conclusions:
- A substantial number of QIs exist for pediatric asthma care in EDs.
- There is a notable lack of outcome and structure indicators.
- Disparities in QI compliance necessitate targeted interventions to improve ED pediatric asthma care.
Introduction:
The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care.
Methods:
We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools.
Results:
We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances.
Conclusions:
A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.
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