Asthma
Conditions
Brief summary
Background: Asthma affects nearly 10% of American children, and is a leading cause of pediatric emergency visits and hospitalizations. Clinical pathways are operational versions of practice guidelines aimed at the hospital management of common illnesses. Single-site studies of pediatric asthma pathways have shown significant improvements in quality of care. Primary Objective: To evaluate the effectiveness of clinical pathways for improving quality of care for children with asthma in a diverse, national sample of emergency department (ED) and hospital settings. Primary Endpoints: 1. Emergency Department: The proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival 2. Inpatient/Hospital: Mean length of hospital stay Study Design: This project will be implemented through an established quality improvement collaborative of hospitals across the United States, the Value in Inpatient Pediatrics Network (part of the American Academy of Pediatrics). A cluster randomized design will be employed. Group 1 hospitals will receive a multifaceted implementation strategy that includes: 1) a pathway implementation toolkit, 2) local multidisciplinary champions in the ED and inpatient settings, 3) audit and feedback, 4) educational seminars, and 5) practice facilitation (via teleconference). Group 2 will receive the same intervention with the addition of a mobile app pathway tool.
Interventions
BEHAVIORALPIPA Intervention Bundle 1
The PIPA intervention bundle 1 includes: 1. Pathway Implementation Toolkit 2. Local Multidisciplinary Champions 3. Audit and Feedback 4. Educational Seminars/Webinars 5. Practice Facilitation
BEHAVIORALPIPA Intervention Bundle 2
The PIPA intervention bundle 2 includes: 1. Pathway Implementation Toolkit 2. Local Multidisciplinary Champions 3. Audit and Feedback 4. Educational Seminars/Webinars 5. Practice Facilitation 6. Mobile App
Sponsors
American Academy of Pediatrics
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Participant/Local champion Eligibility Criteria: Inclusion Criteria: * Working as a physician at the study site
Exclusion criteria
* None Patient/child eligibility criteria: Inclusion Criteria: * Age 2-17 years * Primary diagnosis of asthma
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Hospital/Inpatient: Mean length of hospital stay | 1 year |
| Emergency Department: Proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival | 1 year |
Secondary
| Measure | Time frame |
|---|---|
| Hospital/Inpatient: Proportion of children who screen positive for secondhand tobacco smoke exposure whose caregivers are referred to smoking cessation resources | 1 year |
| Hospital/Inpatient: Proportion of children prescribed antibiotics at hospital discharge | 1 year |
| Hospital/Inpatient: Proportion of children with emergency department visits or readmissions to the hospital within 7 days | 1 year |
| Hospital/Inpatient: Proportion of children transferred to a higher level of care | 1 year |
| Hospital/Inpatient: Proportion of children with administration of bronchodilator via metered-dose inhaler early in hospitalization | 1 year |
| Emergency Department: Proportion of children who have chest radiographs performed | 1 year |
| Emergency Department: Proportion of children admitted to the hospital | 1 year |
| Emergency Department: Proportion of children transferred to a higher level of care | 1 year |
| Emergency Department: Mean length of emergency department stay | 1 year |
| Emergency Department: Proportion of children who get an asthma exacerbation severity assessment at ED triage | 1 year |
| Hospital/Inpatient: Proportion of children screened for secondhand tobacco smoke exposure | 1 year |
Countries
United States
Outcome results
None listed