Interventions improve asthma care for hospitalized children: report
MelissaJenco, News Content Editor
Asthma care improved at eight Utah hospitals after researchers implemented a standardized
intervention model. The team saw declines in readmissions and lengths of hospital
“Interventions implemented during a short hospital stay … can have a long-term impact,”
said Flory L. Nkoy, M.D., M.S., M.P.H., lead author of the quality report Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals (Nkoy FL, et al. Pediatrics. Nov. 2, 2015, http://pediatrics.aappublications.org/content/early/2015/10/28/peds.2015-0285). Dr. Nkoy is associate research professor of pediatrics at the University of Utah
School of Medicine.
The report follows up on the researchers’ previous studies on asthma (bit.ly/1SmcWdy and bit.ly/1RtopqR) and calls the illness “the most frequent reason for preventable emergency department
(ED) and hospital admissions among children in the U.S.”
The study included children between 2 and 17 years at Primary Children’s Hospital
(PCH), which is a tertiary care children’s hospital, and seven community hospitals.
The team looked at how well its evidence-based care process model (EB-CPM) was working
at PCH where it was implemented in 2008 and 2009 and at the community hospitals where
it was disseminated in 2011.
The EB-CPM includes assessments of asthma severity, recommendations for asthma control
and algorithms for using albuterol and oxygen. It also provides criteria for a variety
of situations, including consulting a specialist, transferring a patient to the pediatric
intensive care unit (PICU), discharging a patient and transitioning a patient to a
primary care provider.
During the study period, 3,510 children with asthma were discharged from PCH, and
1,721 were discharged from community hospitals.
At PCH, baseline compliance with the asthma quality measures was 45%. After implementation
of the model, compliance stayed above 90% over five years. During those five years,
the average asthma readmission rate and length of stay at PCH dropped significantly
and stayed down. There was a slight reduction in hospitalization costs and no change
in the use of hospital resources. There also was no change in PICU transfers or deaths.
At the community hospitals, baseline compliance scores ranged from 25% to 58% but
reached 80% to 99% within six months and stayed there for the next two years. After
implementation, the readmission rate dropped slightly but not enough to be statistically
significant. There was a reduction in length of stay and hospitalization cost, and
a small increase in the use of hospital resources. Like PCH, there was no change in
the rate of PICU transfers or deaths.
Co-author Bernhard A. Fassl, M.D., said getting doctors to embrace change was a challenge
in some cases.
“I think for me the surprising thing was how simple the actual medicine is that we
tried to disseminate and how difficult it was to bring providers along and convince
them that there is a good evidence base for doing it a certain way,” said Dr. Fassl,
assistant professor of pediatrics at the University of Utah School of Medicine.
The study’s limitations included a small sample size at the community hospitals, possible
readmissions at hospitals in other systems, a relatively complex intervention model,
unmeasured variables and the inclusion of children with a primary diagnosis of asthma
Researchers said they hope to continue implementing the model in different settings.