A significant gap exists between the evidence for best asthma care practices and the care provided to hospitalized children. Readmission rates remain high and are associated with multiple factors including 1) provider non-compliance with evidence-based (EB) asthma preventive measures, 2) poorly executed post- hospital care transitions, and 3) patient non-compliance with asthma home therapy. We will, conduct a study to evaluate the implementation of a successful pediatric asthma EB care process model (EB-CPM) as we disseminate the EB-CPM from an academic medical facility to Utah hospitals in urban and rural communities. Children hospitalized with asthma are our target population (an AHRQ priority population). We developed and successfully implemented an EB-CPM that spans inpatient and transition to ambulatory asthma care at an academic tertiary care pediatric hospital-Primary Children's Medical Center (PCMC), Salt Lake City, UT, establishing the feasibility of the EB-CPM in an academic setting. We recently added a novel strategy using a self-monitoring scorecard to optimize ambulatory asthma care and decrease the risk for ED/hospital readmissions. By implementing the EB-CPM in different hospital settings (types, size, location, population served, etc), we will be able to identify critical organizational factors associated with successful implementation of the EB-CPM that can be generalized to other facilities nationwide. We will achieve our objectives through the following Specific Aims.
Aim 1 : Implement the EB-CPM at 3 urban and 3 rural community hospitals.
Aim 2 : Determine organizational factors associated with successful implementation of the EB-CPM at 6 community hospitals and PCMC: 2.a. determine the success of the EB-CPM implementation by measuring provider compliance with asthma acute and preventive quality measures;and 2.b. conduct semi-structured surveys of implementation participants to identify organizational factors associated with successful implementation of the EB-CPM across these facilities.
Aim 3 : Evaluate the impact of implementing the EB-CPM by measuring change in 1) hospital length of stay, 2) cost, and 3) ED/hospital readmission rates.
Aim 4 : Evaluate the extent to which use of the self-monitoring scorecard improves post-hospitalization ambulatory asthma care and reduces ED/hospital readmissions: 4.a. survey patients/parents about their use of the scorecard and their perceived self-management skills about asthma;and 4.b. analyze the associated impact of the scorecard on use of severity appropriate preventive medications in ambulatory settings and on ED/hospital readmission. Study results will facilitate broader dissemination of the pediatric asthma EB-CPM at other Intermountain Healthcare facilities and medical facilities nationwide. Broad implementation of the EB-CPM will result in major improvement in asthma care delivery and outcomes including reduced readmissions for children hospitalized with asthma.
Findings from this project will facilitate broader dissemination of the pediatric asthma EB-CPM regionally and nationally, and will provide a novel approach for improving both hospital and post-discharge ambulatory asthma care, thereby reducing asthma-associated readmissions and costs in children.
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|Fassl, Bernhard A; Nkoy, Flory L; Stone, Bryan L et al. (2012) The Joint Commission Children's Asthma Care quality measures and asthma readmissions. Pediatrics 130:482-91|