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Improving the management of acute asthma in children through an integrated care pathway: an implementation study
Marta Montejo1, Natalia Paniagua2, Alvaro Sanchez3,4
1San Vicente Health Centre, Barakaldo-Sestao Integrated Health Organization, Basque Health Service-Osakidetza, Barakaldo, Spain.
Insights
This study evaluates an Asthma Integrated Care Pathway (AICP) for children with acute asthma. The AICP aims to improve care consistency and adherence to guidelines across primary and hospital settings.
Area of Science:
- Pediatric Respiratory Medicine
- Healthcare Implementation Science
- Clinical Quality Improvement
Background:
- Acute asthma episodes in children present significant variability in care across primary and hospital settings.
- Current care often lacks consistent adherence to clinical practice guidelines, impacting pediatric asthma outcomes.
- Integrated care pathways offer a structured approach to standardize management and improve patient care.
Purpose of the Study:
- To evaluate the effectiveness and feasibility of implementing an Asthma Integrated Care Pathway (AICP).
- To improve care quality and reduce variability for children with acute asthma episodes.
- To assess guideline adherence and patient satisfaction within a real-world healthcare system.
Main Methods:
- A cluster quasi-experimental implementation trial with a matched control group across two health districts.
- Intervention group receives cumulative implementation of AICP components over two 12-month periods.
- Mixed methods evaluation using the RE-AIM framework, including professional outcomes, feasibility, and patient experience.
Main Results:
- Effectiveness of AICP assessed at 12, 24, and 36 months on care and implementation outcomes.
- Feasibility and physician perspectives on AICP implementation will be evaluated.
- Patient experience and satisfaction with clinical care will be measured through discussion groups.
Conclusions:
- This real-world study extends knowledge of asthma care pathways beyond emergency settings into primary care.
- Findings aim to guide health systems in reducing care variability and increasing guideline adherence.
- The AICP has the potential to improve pediatric asthma outcomes across the healthcare continuum.
Introduction:
This study aims to evaluate the effectiveness and feasibility of the implementation of an Asthma Integrated Care Pathway (AICP) to improve care and reduce variability according to recommended clinical practice guidelines, for children presenting with acute asthma episodes in paediatric primary care, and hospital services including emergency departments.
Methods And Analysis:
A cluster quasi-experimental implementation trial with a matched control group will be launched in a regional healthcare service. All the paediatric healthcare professionals providing care in two health districts (HDs) will receive interventions over two 12-month periods during which components of the implementation strategy to favour adoption of the AICP will be deployed cumulatively. A selected set of professionals from the same levels of care in the other HDs (N = 11) will serve as the comparison group. The target population of the AICP is children between 2 and 14 years old presenting with an acute asthma episode during the study period. A mixed methods evaluation guided by the RE-AIM framework will assess the effectiveness of the AICP after 12, 24, and 36 months in a set of pre-specified care and implementation outcomes at the professional level. The perceived feasibility of the AICP and its implementation from the perspective of physicians and the experience and satisfaction of patients concerning the clinical care received will be assessed through discussion groups.
Discussion:
This study performed in real-world settings will contribute in extending knowledge in asthma care pathways beyond emergency settings into primary care and across the healthcare continuum. In addition, its findings aim to guide health systems in reducing variability in care, increasing guideline adherence, and ultimately improving paediatric asthma outcomes across the system.
Clinical Trial Registration:
ClinicalTrials.gov, identifier [NCT06437444].
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