Enhancing Healthcare Quality for Hospitalized Children
Sunitha Kaiser, M.D., M.Sc.
Associate Professor of Pediatrics, Epidemiology and Biostatistics
University of California, San Francisco (UCSF)
“I cannot overstate the tremendous impact that AHRQ funding has had on my career. It has allowed me to address important research questions, receive valuable mentorship, and strengthen my knowledge in the pediatric healthcare field.”
Asthma is a leading cause of pediatric hospitalizations in the United States. Despite broad dissemination of evidence-based guidelines for asthma management, there are significant variations in care and outcomes for children hospitalized with asthma, largely due to the challenges of putting guidelines into practice.
With AHRQ funding, Sunitha Kaiser, M.D., M.Sc., has studied and identified strategies to improve the quality, safety, and effectiveness of how healthcare providers integrate the latest research findings into practice. She primarily focuses on care for children hospitalized with respiratory illnesses, including asthma.
“The sheer volume and fast pace in which providers receive new research and guidelines can lead to implementation challenges,” said Dr. Kaiser, an Associate Professor of Pediatrics, Epidemiology and Biostatistics at the University of California, San Francisco (UCSF). “Poor adherence to guidelines contributes to suboptimal health outcomes for children, including longer recovery time, prolonged hospital stay, increased risk of transfer to intensive care, and increased risk of hospital readmission,” she continued.
A detailed plan that guides clinicians through evidence-based care of specific conditions informed by national guidelines—called clinical pathway—has been shown to improve guideline adherence and the quality of care for children hospitalized with asthma. However, “there is limited guidance on how to implement clinical pathways successfully,” said Dr. Kaiser.
Dr. Kaiser received an AHRQ Mentored Clinical Scientist Research Career Development Award in 2016 to identify best practices for clinical pathway implementation to improve healthcare quality for children hospitalized with asthma and then test these practices in a multi-center study. She identified hospitals with significant quality gains after pathway implementation and found certain practices were common to such sites, including using a data-driven approach and engaging multi-disciplinary healthcare providers. She found these pathway implementation practices were feasible and effective in other hospitals as well, including small community hospitals. Additionally, she identified hospital site characteristics associated with improvements in pediatric asthma care. Her study also found that improvements in clinician compliance with evidence-based guidelines was significantly higher in emergency departments in non-teaching hospitals compared with teaching hospitals in which trainees are involved in healthcare delivery.
“Trainees may be less familiar with evidence-based guidelines,” noted Dr. Kaiser. “They also rotate through multiple care settings, creating rapid turnover that necessitates greater educational and training efforts around guidelines.” As part of her study, Dr. Kaiser also identified potential strategies to increase guideline compliance in teaching settings. These include engaging trainees in quality improvement efforts; conducting scheduled, recurring educational meetings; providing online educational resources; and developing clinical decision support tools such as mobile applications.
Towards the end of her initial project, the COVID-19 pandemic emerged in the United States. In 2020, Dr. Kaiser received supplemental AHRQ funding to expand her project to identify significant changes in healthcare delivery during the pandemic and quality and safety implications for hospitalized children.
Dr. Kaiser identified several impacts to clinical workflows and hospital operations during the pandemic that may have affected inpatient pediatric quality and safety. Her study highlighted the importance of certain key strategies for managing crises in hospital operations, such as multi-modal, frequent communication.
Continuing with her focus on high-quality healthcare for children, Dr. Kaiser received another AHRQ grant in 2020 to identify hospital-level factors and strategies to promote sustained guideline adherence and delivery of high-quality care for children with asthma in general hospitals. She identified promising strategies for promoting sustainability, including electronic order sets and investing in local champions.
Dr. Kaiser currently is a co-principal investigator on an AHRQ project that will host a series of research development conferences to inspire attendees to identify barriers and facilitators to ensure the best health outcomes for hospitalized children. Invited stakeholders will include multidisciplinary pediatric hospital medicine clinicians, clinical and health services researchers, patients and families, health equity experts, and policymakers. Three virtual conferences are expected to occur in 2022.
Dr. Kaiser mentors junior faculty, fellows, and students from around the country in career development and a wide array of research, including clinical, health services, implementation science, and quality improvement. She is a member of the Academic Pediatric Association and the American Academy of Pediatrics.
Related AHRQ Resources
Principal Investigator: Sunitha Kaiser, M.D., M.Sc.
Institution: University of California, San Francisco
Grantee Since: 2016
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.