Sunitha V Kaiser1, Brittany Jennings2, Jonathan Rodean3, Michael D Cabana4,5, Matthew D Garber6, Shawn L Ralston7, Bernhard Fassl8, Ricardo Quinonez9, Joanne C Mendoza10, Charles E McCulloch4, Kavita Parikh11. 1. Department of Pediatrics, University of California, San Francisco, San Francisco, California; sunitha.kaiser@ucsf.edu. 2. American Academy of Pediatrics, Itasca, Illinois. 3. Children's Hospital Association, Lenexa, Kansas. 4. Department of Pediatrics, University of California, San Francisco, San Francisco, California. 5. Philip R. Lee Institute for Health Policy Studies, San Francisco, California. 6. Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida. 7. Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland. 8. Department of Pediatrics, The University of Utah, Salt Lake City, Utah. 9. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 10. Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and. 11. Children's National Hospital, Washington, District of Columbia.
Abstract
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 = 12 013 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.
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 = 12 013 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.
Authors: Christopher P Bonafide; Rui Xiao; Amanda C Schondelmeyer; Amy R Pettit; Patrick W Brady; Christopher P Landrigan; Courtney Benjamin Wolk; Zuleyha Cidav; Halley Ruppel; Naveen Muthu; Nathaniel J Williams; Enrique Schisterman; Canita R Brent; Kimberly Albanowski; Rinad S Beidas Journal: Implement Sci Date: 2022-10-21 Impact factor: 7.960
Authors: Sravya Jaladanki; Sarah B Schechter; Marquita C Genies; Michael D Cabana; Roberta S Rehm; Eric Howell; Sunitha V Kaiser Journal: Health Serv Res Date: 2021-09-07 Impact factor: 3.402
Authors: Uli Fehrenbach; Timo A Auer; Wenzel Schöning; Moritz Schmelzle; Christian Jürgensen; Thomas Malinka; Marcus Bahra; Dominik Geisel; Timm Denecke Journal: Abdom Radiol (NY) Date: 2021-02-15
Authors: Amanda C Schondelmeyer; Amanda P Bettencourt; Rui Xiao; Rinad S Beidas; Courtney Benjamin Wolk; Christopher P Landrigan; Patrick W Brady; Canita R Brent; Padmavathy Parthasarathy; Andrew S Kern-Goldberger; Nathaniel Sergay; Vivian Lee; Christopher J Russell; Julianne Prasto; Sarah Zaman; Kaitlyn McQuistion; Kate Lucey; Courtney Solomon; Mayra Garcia; Christopher P Bonafide Journal: JAMA Netw Open Date: 2021-09-01