Improving the Delivery of Quality Evidence-Based Inpatient Asthma Care.

Abstract

Evidence-based care guidelines and clinical pathways are central to quality, equitable, and standardized pediatric asthma care. We sought to improve delivery of optimal guideline-concordant asthma care, defined as documentation of (1) medical and social-environmental risk assessment, (2) a maintenance medication plan, and (3) accurate asthma action plan at discharge. Specifically, we sought to increase the proportion of hospital medicine patients receiving all 3 components from 15% to 80% over 12 months. Our multidisciplinary team defined and operationalized optimal inpatient asthma care using the chronic care model, published literature, and local expert input. Interventions focused on guideline-concordant clinical decision support and educational tools aligned to recently updated Global Initiative for Asthma guidelines, enhanced interdisciplinary communication, and redefined inpatient care processes. Process measures included bundled all-or-none completion of the 3 optimal care components. Outcome measures included 30- and 90-day asthma-related readmissions, length of stay, and rates of inhaled corticosteroid-containing prescription regimens at hospital discharge. Over 12 months of interventions, receipt of optimal asthma care improved from 15% to 69%. Independently, there were notable increases in completion of all 3 components of optimal care. For example, medication maintenance plans, as defined by rates of inhaled corticosteroid prescriptions at hospital discharge, notably increased in alignment with asthma guidelines, from 71% to 80% (P = .002). We also noted a reduction in length of stay and 90-day readmission rates. Multidisciplinary interventions targeting clinical decision support and interdisciplinary communication were associated with improved receipt of guideline-concordant care and reduced readmissions.