TY - JOUR
T1 - Improving pediatric asthma care and outcomes across multiple hospitals
AU - Nkoy, Flory
AU - Fassl, Bernhard
AU - Stone, Bryan
AU - Uchida, Derek A.
AU - Johnson, Joseph
AU - Reynolds, Carolyn
AU - Valentine, Karen
AU - Koopmeiners, Karmella
AU - Kim, Eun Hea
AU - Savitz, Lucy
AU - Maloney, Christopher G.
N1 - Publisher Copyright:
© 2015 by the American Academy of Pediatrics.
PY - 2015/12
Y1 - 2015/12
N2 - BACKGROUND AND OBJECTIVES: Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals. METHODS: Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses. RESULTS: At PCH, the CS increased and remained at >90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P =.026) and length of stay (P <.001), a trend toward reduced costs (P =.094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting >2 years after dissemination, with a slight but not significant readmission reduction (P =.119), a significant reduction in length of stay (P <.001) and cost (P =.053), a slight increase in hospital resource use (P =.032), and no change in ICU transfers or deaths. CONCLUSIONS: Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.
AB - BACKGROUND AND OBJECTIVES: Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals. METHODS: Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses. RESULTS: At PCH, the CS increased and remained at >90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P =.026) and length of stay (P <.001), a trend toward reduced costs (P =.094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting >2 years after dissemination, with a slight but not significant readmission reduction (P =.119), a significant reduction in length of stay (P <.001) and cost (P =.053), a slight increase in hospital resource use (P =.032), and no change in ICU transfers or deaths. CONCLUSIONS: Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.
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U2 - 10.1542/peds.2015-0285
DO - 10.1542/peds.2015-0285
M3 - Article
C2 - 26527553
AN - SCOPUS:84948844575
SN - 0031-4005
VL - 136
SP - e1602-e1610
JO - Pediatrics
JF - Pediatrics
IS - 6
ER -