Effectiveness of a Clinical Pathway for Inpatient Asthma Management

Johnson, Kevin B.; Blaisdell, Carol J.; Walker, Allan David; Eggleston, Peyton A.

doi:10.1542/peds.106.5.1006

Cited by 127 publications

(139 citation statements)

References 19 publications

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“…Additionally, in the time frame between this publication and the current study, many hospitals worked to standardize asthma hospitalizations by creating weaning protocols for albuterol, thereby decreasing LOS for all asthmatics, which may also affect the differences in LOS between groups of obese and nonobese patients. 35 Woolford et al found approximately a one-half-day increase in LOS and $2,000 higher mean charges for patients admitted with status asthmaticus and a secondary diagnosis of obesity. 8,9 Study location and differing methods for defining obesity may account for the discrepancy between Woolford's findings and our study.…”

Section: Discussionmentioning

confidence: 99%

Childhood obesity and in-hospital asthma resource utilization

et al. 2014

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OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for inhospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS:Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/ clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization.CONCLUSIONS: Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful. Pediatric hospitalizations for obesity-related conditions have doubled in the last decade, mirroring the trend of higher levels of childhood obesity in the United States. [1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting. The studies examining this association have found patients with obesity to have a longer hospital length of stay (LOS) and i...

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Section: Discussionmentioning

confidence: 99%

Childhood obesity and in-hospital asthma resource utilization

et al. 2014

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“…21 However, given that these types of hospitals are serving a disproportionately large share of medically complex and low-SES children, these hospitals should prioritize implementation of interventions shown to improve quality of care for children admitted with respiratory illness. Single-center studies have shown clinical pathways improve antimicrobial use 38 and reduce radiation exposure, video-assisted thoracoscopic surgery procedures, and readmission rates in children admitted for pneumonia 9 ; reduce resource utilization, [39][40][41] LOS, 41 and readmissions 8 in children admitted for bronchiolitis; and increase home asthma management teaching 7 and decrease in LOS 5,42 in children admitted for asthma. Larger, multicenter studies are needed to determine if clinical pathways are an effective means of improving quality of care for respiratory illnesses, and if pathways are found to be effective, policies should incentivize large, urban-teaching hospitals to implement pathways.…”

Section: Discussionmentioning

confidence: 99%

“…4 At the hospital level, many institutions have implemented interventions such as clinical pathways or practice guidelines to improve care for children hospitalized for respiratory illnesses. [5][6][7][8][9] However, such interventions require substantial commitment of resources toward development, implementation, and maintenance. 10 Ideally, interventions to improve care should be targeted toward high-risk patients or hospitals.…”

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confidence: 99%

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Kaiser

Bakel

Okumura

et al. 2015

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVES:Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). METHODS:Cross-sectional study of hospitalizations of patients ,18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (.90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions). RESULTS:

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“…The development of a clinical pathway for children with acute asthma is worthwhile because it has been demonstrated that the implementation of structured care reduces hospital stay without increased morbidity. 8,13 Although several asthma scores have been developed and proven useful in clinical pathways, 1-7 all of these pediatric asthma scores require auscultation of the lungs to score the degree of wheezing or air entry. This implies that all health-care providers should be trained to auscultate the lungs.…”

Section: Discussionmentioning

confidence: 99%

“…One study evaluated in-patient asthma management by means of a clinical pathway and included a weaning protocol for bronchodilator administration. 13 This weaning guideline was based on 4 items, including assessment of lung sounds. In addition, a nurse determined the criteria to change the frequency of therapy and notified the house officer, who subsequently assessed the patient and ordered a change of therapy.…”

Section: Discussionmentioning

confidence: 99%