Pathways for Improving Inpatient Pediatric Asthma Care (PIPA): A Multicenter, National Study
- 1 June 2020
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 145 (6)
- https://doi.org/10.1542/peds.2019-3026
Abstract
This multicenter study analyzes the effects of pediatric inpatient asthma pathways on quality of care across varied hospital settings. BACKGROUND AND OBJECTIVES:Pathways guide clinicians through evidence-based care of specific conditions. Pathways have been demonstrated to improve inpatient asthma care but mainly in studies at large, tertiary children's hospitals. It remains unclear if these effects are generalizable across diverse hospital settings. Our objective was to improve inpatient asthma care by implementing pathways in a diverse, national sample of hospitals.METHODS:We used a learning collaborative model. Pathway implementation strategies included local champions, external facilitators and/or mentors, educational seminars, quality improvement methods, and audit and feedback. Outcomes included length of stay (LOS) (primary), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits (balancing). Hospitals reviewed a sample of up to 20 charts per month of children ages 2 to 17 years who were admitted with a primary diagnosis of asthma (12 months before and 15 months after implementation). Analyses were done by using multilevel regression models with an interrupted time series approach, adjusting for patient characteristics.RESULTS:Eighty-five hospitals enrolled (40 children's and 45 community); 68 (80%) completed the study (n = 12013 admissions). Pathways were associated with increases in early administration of metered-dose inhalers (odds ratio: 1.18; 95% confidence interval [CI]: 1.14-1.22) and referral to smoking cessation resources (odds ratio: 1.93; 95% CI: 1.27-2.91) but no statistically significant changes in other outcomes, including LOS (rate ratio: 1.00; 95% CI: 0.96-1.06). Most hospitals (65%) improved in at least 1 outcome.CONCLUSIONS:Pathways did not significantly impact LOS but did improve quality of asthma care for children in a diverse, national group of hospitals.This publication has 39 references indexed in Scilit:
- Systematic review of the Hawthorne effect: New concepts are needed to study research participation effectsJournal of Clinical Epidemiology, 2013
- Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for InterventionThe Journal of Pediatrics, 2013
- Evaluating the effect of an asthma self-management intervention for rural familiesJournal of Asthma, 2013
- Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthmaEmergencias, 2013
- Interrupted time-series analysis yielded an effect estimate concordant with the cluster-randomized controlled trial resultJournal of Clinical Epidemiology, 2013
- Hospital-Level Compliance With Asthma Care Quality Measures at Children's Hospitals and Subsequent Asthma-Related OutcomesJAMA, 2011
- Research in action: using positive deviance to improve quality of health careImplementation Science, 2009
- Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma–Summary Report 2007Journal of Allergy and Clinical Immunology, 2007
- Improved outcomes for hospitalized asthmatic children using a clinical pathwayAnnals of Allergy, Asthma & Immunology, 2000
- Why Don't Physicians Follow Clinical Practice Guidelines?JAMA, 1999