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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Simultaneously implementing pathways for improving asthma, pneumonia, and bronchiolitis care for hospitalized
Yeelen Edwards1, Nancy Yang1, Andrew D Auerbach2
1Department of Pediatrics, University of California, San Francisco, California, USA.
Insights
This study evaluates a multicondition clinical pathway intervention for pediatric asthma, pneumonia, and bronchiolitis in community hospitals. The goal is to improve guideline adherence and patient outcomes, addressing barriers to implementation.
Area of Science:
- Pediatric hospital medicine
- Implementation science
- Clinical pathways
Background:
- Asthma, pneumonia, and bronchiolitis are leading causes of pediatric hospitalization in the US, incurring significant costs.
- Suboptimal clinician adoption of evidence-based guidelines contributes to adverse patient outcomes, including prolonged hospital stays and readmissions.
- A previous study demonstrated the benefits of a multicondition clinical pathway intervention in a children's hospital, but its effectiveness in community settings remains unstudied.
Purpose of the Study:
- To assess the implementation and effectiveness of a multicondition clinical pathway intervention for hospitalized children with asthma, pneumonia, or bronchiolitis in community hospitals.
- To address unique implementation barriers faced by community hospitals.
Main Methods:
- A pragmatic, hybrid effectiveness-implementation, cluster-randomized trial design.
- Community hospitals will be randomized (1:1) to either the intervention or a wait-list control group.
- Primary outcome: sustained adoption of evidence-based practices over 2 years. Secondary outcomes: hospital length of stay, ICU transfer rates, and readmission rates.
Main Results:
- The study is ongoing, with enrollment projected to complete in September 2024.
- Primary analysis is anticipated in March 2025, with results to follow.
- No results are available yet as the study is in progress.
Conclusions:
- This hybrid trial aims to provide a comprehensive understanding of the pragmatic and sustainable implementation of multicondition pathway interventions in community hospitals.
- The study will assess the impact of the intervention on patient health outcomes.
- Findings will inform future strategies for improving care for hospitalized children with common respiratory illnesses.
Background:
Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the United States, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. The majority of these hospitalizations occur in general/community hospitals. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these illnesses, including longer recovery time/hospital stay, higher rates of intensive care unit transfer, and increased risk of hospital readmission. A prior single-center study at a children's hospital tested a multicondition clinical pathway intervention (simultaneous implementation of multiple pathways for multiple pediatric conditions) and demonstrated improved clinician guideline adherence and patient health outcomes. This intervention has not yet been studied in community hospitals, which face unique implementation barriers.
Objective:
To study the implementation and effectiveness of a multicondition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals.
Methods:
We will conduct a pragmatic, hybrid effectiveness-implementation, cluster-randomized trial in community hospitals around the United States (1:1 randomization to intervention vs. wait-list control). Our primary outcome will be the adoption of two to three evidence-based practices for each condition over a sustained period of 2 years. Secondary outcomes include hospital length of stay, ICU transfer, and readmission.
Discussion:
This hybrid trial will lead to a comprehensive understanding of how to pragmatically and sustainably implement a multicondition pathway intervention in community hospitals and an assessment of its effects. Enrollment began in July 2022 and is projected to be completed in September 2024. Primary analysis completion is anticipated in March 2025, with reporting of results following.
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