小児急性喘息の統合ケアパスによる管理改善

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.

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.

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.

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.