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
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) |
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.