Sunitha V Kaiser1, Jonathan Rodean2, Arpi Bekmezian3, Matt Hall2, Samir S Shah4, Sanjay Mahant5, Kavita Parikh6, Andrew D Auerbach7, Rustin Morse8, Henry T Puls9, Charles E McCulloch10, Michael D Cabana11. 1. Department of Pediatrics, University of California, San Francisco, CA. Electronic address: Sunitha.Kaiser@ucsf.edu. 2. Division of Research, Children's Hospital Association, Lenexa, KS. 3. Department of Pediatrics, University of California, San Francisco, CA. 4. Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Department of Pediatrics, University of Toronto, SickKids Research Institute, Toronto, Ontario, Canada. 6. Department of Pediatrics, Children's National Health System and George Washington University School of Medicine, Washington, DC. 7. Department of Internal Medicine, University of California, San Francisco, CA. 8. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. 9. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 10. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. 11. Department of Pediatrics, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
Abstract
OBJECTIVE: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. STUDY DESIGN: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. RESULTS: Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. CONCLUSIONS: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.
OBJECTIVE: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. STUDY DESIGN: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. RESULTS: Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. CONCLUSIONS: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.
Authors: Christopher P Bonafide; Rui Xiao; Patrick W Brady; Christopher P Landrigan; Canita Brent; Courtney Benjamin Wolk; Amanda P Bettencourt; Lisa McLeod; Frances Barg; Rinad S Beidas; Amanda Schondelmeyer Journal: JAMA Date: 2020-04-21 Impact factor: 56.272
Authors: James W Antoon; Carlos G Grijalva; Cary Thurm; Troy Richardson; Alicen B Spaulding; Ronald J Teufel; Mario A Reyes; Samir S Shah; Julianne E Burns; Chén C Kenyon; Adam L Hersh; Derek J Williams Journal: J Hosp Med Date: 2021-10 Impact factor: 2.899
Authors: Mansi Desai; Katherine Caldwell; Nisha Gupta; Arpi Bekmezian; Michael D Cabana; Andrew D Auerbach; Sunitha V Kaiser Journal: Pediatr Qual Saf Date: 2020-10-26