2004 OPEN FORUM Abstracts
OUTCOMES OF A PEDIATRIC ASTHMA INITIATIVE.
Natalie Napolitano, BS, RRT-NPS, AE-C,
Nancy Collar, RRT-NPS, AE-C, Regina Milteer, MD, Leigh Hume, RN,Dee
Brown, RN, Edna Cruz, MS, CPHQ, June Lyda, RN, Dr. James Lamberti,
MD, FCCP, Thomas Malinowski, RRT, FAARC, Inova Health System, Falls
Church VA.
BACKGROUND: Pediatric asthma constitutes one of the
most frequent admitting diagnoses for children at acute care
facilities. The National Asthma Education and Prevention Program
Expert Guidelines have identified four essential components of asthma
management. These components include assessment and monitoring,
factors impacting asthma severity, pharmacologic therapy, and patient
education. The major components of disease management include
identification of patients at risk, use of evidence-based practice
guidelines and pathways, patient/family disease education and
monitoring and reporting of measurable outcomes. We report on the
effectiveness of our Pediatric Asthma Pathway (PAP) as evidenced by
performance of key clinical activities associated with successful
asthma management.
METHOD: A multidisciplinary Pediatric
Asthma Quality Improvement Team (PAQIT) developed the PAP. The PAQIT
included members of the Inova Health System, the community, local
schools, and outpatient providers. The following outcomes are
retrospectively reviewed to assess the effectiveness of the PAP:
inhaled corticosteroid use prior to admission, inhaled corticosteroid
use during admission, hospital admissions and average length of stay
(ALOS), asthma severity, readmission rate, return to ED within 7
days, average total cost and patient satisfaction with disease
management education.
RESULTS: An exact test for trends
(Cochran-Armitage trend test) was performed on six indicators to
identify statistical significance within respective years (p < .05).
| Indicator – Annual compliance | 2002 | 2003 |
| Pt. Teaching tool completed by discharge? | 89%* | 74%* |
| Inhaled steroid initiated on/before hospital day 3? | 76%* | 70%* |
| Inhaled steroid prescribed at discharge? | 79%* | 74%* |
| Discharge per pathway on/before hospital day 3? | 80%* | 70%* |
| Inhaled steroid prior to admission? | 32% | 38%(p .03) |
| Asthma management plan prior to admission? | 26%(p .04) | 36%(p .002) |
No statistical
significance statistical
significance
The total number of
asthma admissions decreased from 200 in 2000 to 87 in 2003. ALOS has
remained constant at about 2.4 days in spite of a gradual rise in
asthma severity (1.3 in 2000 to 1.6 in 2003). The percentage of
patients readmitted within 60 days is unchanged at 2.8% from
2000-2003. The percentage returning to the ED within 7days has
decreased from 10% in 2000 to 2.7% in 2003.
CONCLUSION:
Hospitals working in concert with the community can develop key
quality indicators that reflect and monitor asthma management
performance.