The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

A PEDIATRIC ASTHMA CARE PATH DECREASES HOSPITAL LENGTH OF STAY, COST, AND CHARGES

Timothy R. Myers RRT. Robert L. Chatburn RRT, Karen McDowell MD, Carolyn Kercsmar MD. Rainbow Babies & Childrens Hospital. Cleveland, OH.

The purpose of this study was to determine the effects of an assessment-driven, algorithm-based care path (ACP) on length of stay, cost, and charges to third party payers for children admitted to our hospital with asthma. METHOD: During the period from 10/1/95 to 12/31/95 patients were entered into the study if they were > 1 year of age, had a history of asthma, an were excluded if they had BPD, CF or congenital anomalies. A control group was established on a separate patient division during the same time span. An historical control group was comprised of data from 1/1/94 through 6/1/95. The ACP is an algorithm to treat asthma patients with standardized assessments and therapy (supplemental oxygen, albuterol aerosols, corticosteriods) at prescribed intervals. The frequency of the assessments and/or treatments was decreased in a step-wise manner dependent on assessment of air exchange, presence of wheezing, accessory muscle usage, oxygenation and FEV1. For those patients that did not respond to this standard treatment path, an intensification protocol was administered (high-dosed albuterol mixed with ipratropium, SC epinephrine, and corticosteriods). Mean values for demographics and outcome variables were compared with t-tests. Percentages by race were compared using a Fisher exact test. Distributions by severity class were compared with the Chi Square test. Results: Demographic and outcome variables are shown in the table as mean values. Comparing the care path and matched control groups, there were no differences in demographic variables or in the distributions by severity class (p>0.999); there were 4 ICU admissions for the care path group vs 3 in the control group, and there were no deaths.

Matched Historical

Care Path Control p Value Control p Value

Demographics

Number 40 47 - 1091 -

Age(years) 9.2 8.3 0.3791 - -

Non-Caucasian 28 34 0.8171 - -

Severity Class

Severe 18 21 - -

Moderate 3 4 - -

Mild 5 5 - -

Unknown 14 17 - -

Outcomes

Length of stay (days)2.5 3.4 0.0005 3.2 < 0.0001 Hospital cost/case $1,820 $2,667 0.0016 $2,835 < 0.0001

Patient charge/case$3,358 $4,987 0.0042 $4,933 < 0.0001

CONCLUSION: A care path to treat pediatric asthma inpatients significantly reducded hospital length of stay, while also resulting in a more cost-effective use of resources. A verage cost (ie, hospital fixed plus variable cost) savings per case was $847. Estimated hospital cost saving per year (based on census of 900 per year) is at least, $762,300. Patient charges to third party payers were also reduced over $1,629 per case.

Reference: OF-96-082

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