Improving management of acute asthma in children through an integrated care pathway
Marta Montejo1,2, Natalia Paniagua2,3,4, Jose Ignacio Pijoan2,5
1San Vicente - Barakaldo. Primary Care Center, Basque Health Service, Barakaldo, Spain.
Insights
An asthma integrated care pathway (AICP) improved adherence to evidence-based practices for paediatric acute asthma (AA) management in primary care and emergency departments. This quality improvement initiative enhanced treatment delivery and symptom assessment.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Clinical Pathways
Background:
- Paediatric acute asthma (AA) management requires adherence to evidence-based practices.
- Gaps often exist between clinical guidelines and real-world application in primary care (PC) and paediatric emergency departments (PED).
Purpose of the Study:
- To evaluate the impact of an asthma integrated care pathway (AICP) on adherence to evidence-based practices for paediatric acute asthma (AA).
- Assess improvements in PC and PED settings through a quality improvement initiative.
Main Methods:
- A 2-year quality improvement initiative (May 2023-April 2025) in Spain.
- Development of a codesigned AICP involving families and clinicians.
- Interventions included training, decision support, education, and audit/feedback; interrupted time series analyses (ITSA) were used.
Main Results:
- Significant increases in metered-dose inhaler (MDI) with holding chamber use (PC: 9.0% to 26.7%; PED: 31.5% to 61.4%).
- Improved documentation of severity (Pulmonary Score) and symptom control (Paediatric Asthma Control Tool) in both settings.
- ITSA revealed differential changes between PC and PED; no impact on PED length of stay, hospitalization, or revisit rates.
Conclusions:
- A structured, codesigned AICP significantly enhanced adherence to recommended paediatric asthma care practices.
- Integrated care pathways are effective in bridging the gap between asthma guidelines and clinical practice.
Objective:
To evaluate the impact of an asthma integrated care pathway (AICP) on adherence to evidence-based practices in the management of paediatric acute asthma (AA) across primary care (PC) and paediatric emergency department (PED) settings.
Methods:
We conducted a 2-year quality improvement initiative (May 2023-April 2025) in two health districts and a regional PED in Spain. The AICP was developed using a design-thinking approach and included input from families and clinicians. Interventions included training, electronic decision support, family education and regular audit and feedback. The primary outcome was the proportion of AA cases treated with bronchodilator via metered-dose inhaler (MDI) with holding chamber. Secondary outcomes included documentation of severity (Pulmonary Score) and symptom control assessment (Paediatric Asthma Control Tool). Interrupted time series analyses (ITSA) were carried out.
Results:
A total of 7241 AA episodes were recorded (4150 PED, 3091 PC). MDI with holding chamber use increased from 9.0% to 26.7% in PC and from 31.5% to 61.4% in PED. Pulmonary Score documentation improved from 16.3% to 45.1% in PC and from 48.4% to 78.7% in PED. Persistent symptom assessment increased from 8.0% to 23.4% and from 32.9% to 67.4% in the PC centres and the PED, respectively. ITSA showed differential patterns of change between PC and PED. No changes were observed in PED length of stay, hospitalisation or revisit rates.
Conclusions:
Implementation of a structured, codesigned AICP significantly improved adherence to recommended asthma care practices. Integrated pathways can effectively bridge the gap between guidelines and practice in paediatric asthma care.
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