Jennifer N Fishe1, Phyllis Hendry2, Jennifer Brailsford3, Ramzi G Salloum4, Bruce Vogel5, Erik Finlay6, Sam Palmer7, Susmita Datta8, Leslie Hendeles9, Kathryn Blake10. 1. Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America; Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America. Electronic address: Jennifer.Fishe@jax.ufl.edu. 2. Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America. Electronic address: Phyllis.Hendry@jax.ufl.edu. 3. Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America. Electronic address: Jennifer.Brailsford@jax.ufl.edu. 4. Department of Health Outcomes and Bioinformatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, United States of America. Electronic address: RSalloum@ufl.edu. 5. Department of Health Outcomes and Bioinformatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, United States of America. Electronic address: BVogel@ufl.edu. 6. GeoPlan Center, University of Florida College of Design, Construction, and Planning. 1480 Inner Rd, Gainesivlle, FL 32601, United States of America. Electronic address: ErikF@geoplan.ufl.edu. 7. GeoPlan Center, University of Florida College of Design, Construction, and Planning. 1480 Inner Rd, Gainesivlle, FL 32601, United States of America. Electronic address: Sam@geoplan.ufl.edu. 8. Department of Biostatistics, University of Florida. 2004 Mowry Road, 5(th) Floor CTRB, Gainesville, FL 32611, United States of America. Electronic address: Susmita.Datta@ufl.edu. 9. Department of Pediatrics, Pediatric Pulmonary Division, University of Florida College of Medicine, 1600 SW Archer Rd, Ste HD-506, Gainesville, FL 32610, United States of America. 10. Nemours Center for Pharmacogenomics and Translational Research, 807 Children's Way, Jacksonville, FL 32207, United States of America. Electronic address: Kathryn.Blake@nemours.org.
Abstract
BACKGROUND: Pediatric asthma exacerbations are a frequent reason for emergency care. Early administration of oral systemic corticosteroids (OCS) in the emergency department (ED) decreases hospitalization rates and ED length-of-stay (LOS). However, it is unknown whether even earlier OCS administration by emergency medical services (EMS) in the prehospital setting further improves outcomes. PURPOSE: To describe the background and methods of a type 1 hybrid effectiveness-implementation trial of EMS-administered OCS for pediatric asthma patients incorporating a stepped wedge design and the RE-AIM framework. METHODS: The study employs a non-randomized stepped wedge design where multiple EMS agencies adopt OCS as a treatment for pediatric asthma exacerbations at varying times. This design accommodates ethical considerations of studying pediatric subjects in the prehospital setting where informed consent is not feasible. We will compare hospitalization rates, ED LOS, and short-term healthcare costs between pediatric asthma patients who do and do not receive OCS from EMS. Using geographic information systems (GIS), we will measure how differences in outcomes scale with increasing EMS transport time. We will use the RE-AIM framework to guide a mixed methods analysis of barriers and enablers to EMS administration of OCS for pediatric asthma patients, including quantitative measures of adoption and uptake and qualitative EMS provider focus group data. CONCLUSION: This trial will determine if earlier EMS administration of OCS to pediatric asthma patients decreases hospitalizations, ED LOS, and short-term healthcare costs, and if those outcomes scale with longer EMS transport times. We will identify barriers and enablers to implementing EMS-administered OCS for pediatric asthma patients.
BACKGROUND: Pediatric asthma exacerbations are a frequent reason for emergency care. Early administration of oral systemic corticosteroids (OCS) in the emergency department (ED) decreases hospitalization rates and ED length-of-stay (LOS). However, it is unknown whether even earlier OCS administration by emergency medical services (EMS) in the prehospital setting further improves outcomes. PURPOSE: To describe the background and methods of a type 1 hybrid effectiveness-implementation trial of EMS-administered OCS for pediatric asthmapatients incorporating a stepped wedge design and the RE-AIM framework. METHODS: The study employs a non-randomized stepped wedge design where multiple EMS agencies adopt OCS as a treatment for pediatric asthma exacerbations at varying times. This design accommodates ethical considerations of studying pediatric subjects in the prehospital setting where informed consent is not feasible. We will compare hospitalization rates, ED LOS, and short-term healthcare costs between pediatric asthmapatients who do and do not receive OCS from EMS. Using geographic information systems (GIS), we will measure how differences in outcomes scale with increasing EMS transport time. We will use the RE-AIM framework to guide a mixed methods analysis of barriers and enablers to EMS administration of OCS for pediatric asthmapatients, including quantitative measures of adoption and uptake and qualitative EMS provider focus group data. CONCLUSION: This trial will determine if earlier EMS administration of OCS to pediatric asthmapatients decreases hospitalizations, ED LOS, and short-term healthcare costs, and if those outcomes scale with longer EMS transport times. We will identify barriers and enablers to implementing EMS-administered OCS for pediatric asthmapatients.
Authors: Jennifer N Fishe; Eugene Palmer; Erik Finlay; Carmen Smotherman; Shiva Gautam; Phyllis Hendry; Leslie Hendeles Journal: Pediatr Emerg Care Date: 2019-02-14 Impact factor: 1.454
Authors: Jennifer N Fishe; Remle P Crowe; Rebecca E Cash; Nikiah G Nudell; Christian Martin-Gill; Christopher T Richards Journal: Prehosp Emerg Care Date: 2018-01-19 Impact factor: 3.077
Authors: Scott W Kirkland; Ben Vandermeer; Sandy Campbell; Cristina Villa-Roel; Amanda Newton; Francine M Ducharme; Brian H Rowe Journal: J Asthma Date: 2018-06-22 Impact factor: 2.515