A Retrospective Study Evaluating the Effectiveness of an Asthma Clinical Pathway in Pediatric Inpatient Practice

Edwards, Elisa; Fox, Kristie M.

doi:10.5863/1551-6776-13.4.233

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…Several studies have demonstrated that pathways are effective in improving quality of care and health outcomes for children hospitalized with asthma (3)(4)(5)(6)(7)(8)(9)12). However, none, to our knowledge, have detailed the pathway implementation process across a large, diverse group of hospital settings.…”

Section: Discussionmentioning

confidence: 99%

“…Pathways promote standardization of care, with the aim of improving care quality and decreasing unnecessary healthcare utilization. They have been shown to improve care for children hospitalized with asthma, including increasing use of recommended medications, and decreasing length of hospital stay, healthcare costs, hospital readmissions, and healthcare disparities (3)(4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Implementing pediatric inpatient asthma pathways

et al. 2020

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Objective: Pathways are succinct, operational versions of evidence-based guidelines. Studies have demonstrated pathways improve quality of care for children hospitalized with asthma, but we have limited information on other key factors to guide hospital leaders and clinicians in pathway implementation efforts. Our objective was to evaluate the adoption, implementation, and reach of inpatient pediatric asthma pathways. Methods: This was a mixed-methods study of hospitals participating in a national collaborative to implement pathways. Data sources included electronic surveys of implementation leaders and staff, field observations, and chart review of children ages 2-17 years admitted with a primary diagnosis of asthma. Outcomes included adoption by hospitals, pathway implementation factors, and reach of pathways to children hospitalized with asthma. Quantitative data were analyzed using descriptive statistics and multivariable regression. Qualitative data were analyzed using thematic content analysis. Results: Eighty-five hospitals enrolled; 68 (80%) adopted/completed the collaborative. These 68 hospitals implemented pathways with overall high fidelity, implementing a median of 5 of 5 core pathway components (Interquartile Range [IQR] 4-5) in a median of 5 months (IQR 3-9). Implementation teams reported a median time cost of 78 h (IQR: 40-120) for implementation. Implementation leaders reported the values of pathway implementation included improvements in care, enhanced interdisciplinary collaboration, and access to educational resources. Leaders reported barriers in modifying electronic health records (EHRs), and only 63% of children had electronic pathway orders placed. Conclusions: Hospitals implemented pathways with high fidelity. Barriers in modifying EHRs may have limited the reach of pathways to children hospitalized with asthma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementing pediatric inpatient asthma pathways

et al. 2020

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“…The estimate of its prevalence is variable depending on the criteria used (symptomatic forms or not) and the tools used (none: clinical diagnosis only, monofilament, instrumental quantitative exploration of sensitivity or electroneuromyogram). It is estimated that it reaches about 30% of diabetic subjects at the time of diagnosis [1] with extremes ranging from 8 to 54% in type 1 diabetes and 13 to 46% in type 2 diabetes [2].…”

Section: Introductionmentioning

confidence: 99%

Interest of Sudoscan in the detection of diabetic peripheral neuropathy

Douali¹,

jaafari²,

Rafi³

et al. 2022

World J. Adv. Res. Rev.

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Introduction: Disturbance of pain sensation is considered one of the major initial risk factors for diabetic foot ulcers. Sweat dysfunction leading to abnormal skin conditions, including dryness and fissures, may increase the risk of foot ulcer. The objective of this study was to evaluate the Sudoscan, a new rapid, non-invasive, quantitative method for early detection of diabetic peripheral neuropathy by measuring sweat electrical conduction (SEC). Patients and methods: We conducted this study on 85 type 2 diabetic patients. The data of the study were collected through a questionnaire, clinical examination (DN4, monofilament) and sudoscan for SEC. Results: We recruited 85 patients, the average age of the subjects was 58.32 ± 10.89 years. 77.6% were women and 22.4% were men. A significant proportion (67%) of our study population had a duration of diabetes of less than 10 years, Among 85 patients 40% had a positive DN4 and only 17.2% of the participants had a positive monofilamant test. 52.9% of the patients had a moderate dysfunction of the electrical conduction of sweat (SEC) and only 29.4% had a severe dysfunction, and 17.6% of the patients had a normal conduction we did not objectify a significant correlation between the sudoscan and the other tests notably the DN4 and the monofilament. Conclusion: The Sudoscan is a reproducible technique, with a high specificity, it is a simple test for the detection of neuropathy diabetic peripheral allowing an early prevention of foot lesions.

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“…Pathways have been shown to improve quality of care for children who are hospitalized with asthma by increasing the use of recommended medications such as bronchodilators and corticosteroids, reducing use of antibiotics, decreasing LOS and associated health care costs, and improving health care disparities. [9][10][11][12][13][14] This previous research has primarily consisted of single-center studies in large, tertiary children's hospitals 9 ; however, ,30% of childhood hospitalizations in the United States occur in these settings. 15 Thus, the purpose in our initiative was to improve inpatient asthma care for children by implementing pathways in a diverse, national sample of hospitals.…”

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confidence: 99%

Pathways for Improving Inpatient Pediatric Asthma Care (PIPA): A Multicenter, National Study

et al. 2020

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BACKGROUND AND OBJECTIVES: Pathways guide clinicians through evidence-based care of specific conditions. Pathways have been demonstrated to improve inpatient asthma care but mainly in studies at large, tertiary children's hospitals. It remains unclear if these effects are generalizable across diverse hospital settings. Our objective was to improve inpatient asthma care by implementing pathways in a diverse, national sample of hospitals. METHODS:We used a learning collaborative model. Pathway implementation strategies included local champions, external facilitators and/or mentors, educational seminars, quality improvement methods, and audit and feedback. Outcomes included length of stay (LOS) (primary), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits (balancing). Hospitals reviewed a sample of up to 20 charts per month of children ages 2 to 17 years who were admitted with a primary diagnosis of asthma (12 months before and 15 months after implementation). Analyses were done by using multilevel regression models with an interrupted time series approach, adjusting for patient characteristics.RESULTS: Eighty-five hospitals enrolled (40 children's and 45 community); 68 (80%) completed the study (n = 12 013 admissions). Pathways were associated with increases in early administration of metered-dose inhalers (odds ratio: 1.18; 95% confidence interval [CI]: 1.14-1.22) and referral to smoking cessation resources (odds ratio: 1.93; 95% CI: 1.27-2.91) but no statistically significant changes in other outcomes, including LOS (rate ratio: 1.00; 95% CI: 0.96-1.06). Most hospitals (65%) improved in at least 1 outcome. CONCLUSIONS: Pathways did not significantly impact LOS but did improve quality of asthma care for children in a diverse, national group of hospitals.WHAT'S KNOWN ON THIS SUBJECT: Pathways have been shown to improve quality of care for children who are hospitalized with asthma, but previous research has primarily consisted of singlecenter studies in large, tertiary children' s hospitals.WHAT THIS STUDY ADDS: This multicenter study study of pediatric inpatient asthma pathways included hospitals that varied widely in size, type, location, and structure. We found that pathways were not associated with statistically significant changes in length of stay but were associated with improvements in care quality.

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A Retrospective Study Evaluating the Effectiveness of an Asthma Clinical Pathway in Pediatric Inpatient Practice

Cited by 11 publications

References 6 publications

Implementing pediatric inpatient asthma pathways

Implementing pediatric inpatient asthma pathways

Interest of Sudoscan in the detection of diabetic peripheral neuropathy

Pathways for Improving Inpatient Pediatric Asthma Care (PIPA): A Multicenter, National Study

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