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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 75 Research Studies DisplayedBeck AF, Wymer L, Pinzer E
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
This study’s goal as to determine whether housing renovations affect the prevalence of asthma in an underresourced community. Between 2010 and 2012, the Fay Apartments (~800 units) in Cincinnati, Ohio, were renovated to "green building" standards and renamed the Villages at Roll Hill. Asthma prevalence among 7-year-olds was determined by accessing Ohio Medicaid data for the years 2013 to 2021. Average prevalence of asthma among 7-year-olds averaged 12.7% in the first 6 years after the renovations (2013-2018). But in postrenovation years 7-9 (2019-221), average prevalence of asthma had dropped to 5.9%.
AHRQ-funded; HS027996.
Citation: Beck AF, Wymer L, Pinzer E .
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
J Allergy Clin Immunol Glob 2023 Nov; 2(4):1-4. doi: 10.1016/j.jacig.2023.100143..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Vulnerable Populations, Social Determinants of Health
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Volerman A, Balachandran U, Zhu M
Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial.
The objective of this study was to evaluate whether the technology-based intervention-Virtual Teach-to-Goal (V-TTG) could lead to less inhaler misuse among children hospitalized with asthma. A single-center randomized controlled trial of V-TTG vs brief intervention was conducted with children aged 5-10 with asthma. At baseline, nearly all children misused inhalers; inhaler misuse decreased significantly in both V-TTG and brief intervention. The researchers suggested that future studies evaluate V-TTG intervention across diverse populations and disease severities to identify its greatest impact.
AHRQ-funded; HS027804.
Citation: Volerman A, Balachandran U, Zhu M .
Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial.
Ann Allergy Asthma Immunol 2023 Aug; 131(2):217-23.e1. doi: 10.1016/j.anai.2023.02.023..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Education: Patient and Caregiver, Inpatient Care
Owora AH, Li R R, Tepper RS
Impact of time-varying confounders on the association between early-life allergy sensitization and the risk of current asthma: a post hoc analysis of a birth cohort.
The purpose of this study was to explore whether allergen avoidance in infants genetically predisposed to asthma can weaken the increased risk of current asthma that is associated with early-life allergy sensitization. The researchers utilized a post hoc analysis to estimate the average causal effect of early-life allergy sensitization and allergen avoidance on the risk of current asthma. The study found that that the odds of current asthma were higher among children with an early-life allergy sensitization at 7 years of age. No differences were demonstrated at 15-years of age. Overall, the odds of current asthma were lower among children randomized to the Canadian Asthma Primary Prevention Study (CAPPS) intervention. CAPPS was developed to decrease exposure in the first year of infancy to indoor aeroallergens and to promote prolonged breastfeeding and delayed introduction of milk and solid foods. The study also found that female children had 28% lower odds of current asthma than male children. The researchers concluded that early life is a vital time when allergy sensitization may provoke pathogenesis towards school-age asthma onset, and allergen avoidance during the same period may reduce the risk of current asthma. Confounding due to time-varying allergy sensitization states and asthma-related treatment exposure may explain some of the null associations reported in previous research.
AHRQ-funded; HS026390.
Citation: Owora AH, Li R R, Tepper RS .
Impact of time-varying confounders on the association between early-life allergy sensitization and the risk of current asthma: a post hoc analysis of a birth cohort.
Allergy 2022 Oct;77(10):3141-44. doi: 10.1111/all.15403..
Keywords: Asthma, Respiratory Conditions, Children/Adolescents, Risk
Bell N, Lòpez-De Fede A, Cai B
Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures.
This retrospective cohort study examined geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures for pediatric patients with either attention deficit/hyperactivity disorder (ADD, ages 6-12) or asthma (MMA, ages 5-18) defined using Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. The authors investigated differences in avoidable and potentially avoidable ED visits by the beneficiary's primary care medical home (PCMH) attribution type and in relation to differences in proximity to their primary care providers versus hospitals. There was a 2.4 percentage point reduction in risk of avoidable emergency department (ED) visits among children in the ADD cohort who attended a PCMH versus those who did not which increased to 3.9 to 7.2 percentage points as relative proximity to primary care providers versus hospitals improved. Children in the ADD and MMA cohorts who were enrolled in a PCMH but did not attend one for primary care services exhibited a 5.4 and 3.0 percentage point increase in avoidable ED visits compared to children who were unenrolled and did not attend medical homes, but these differences were only observed when geographic proximity to hospitals was more convenient than primary care providers.
AHRQ-funded; HS026263.
Citation: Bell N, Lòpez-De Fede A, Cai B .
Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures.
PLoS One 2022 Sep 6;17(9):e0273805. doi: 10.1371/journal.pone.0273805..
Keywords: Children/Adolescents, Primary Care, Asthma, Medicaid, Emergency Department
Kim B, Mulready-Ward C, Thorpe LE
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
This study assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing, and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). The authors used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma (“ever asthma”) and experiencing an asthma attack within the past year. They also examined whether associations were modified by smoking status (among adults), smoking within the house (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma and past-year asthma attack. Rental assistance housing living was also significantly associated with ever asthma. Public or rental assistance housing associations and ever asthma were marginally significant among children but were more pronounced among ever smokers than among never smokers.
AHRQ-funded; HS026120.
Citation: Kim B, Mulready-Ward C, Thorpe LE .
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
Prev Med 2022 Aug;161:107147. doi: 10.1016/j.ypmed.2022.107147..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Vulnerable Populations, Urban Health, Chronic Conditions
Campbell JI, Dubois MM, Savage TJ
Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019.
This study’s objective was to identify subgroups likely to benefit from monoclonal antibody and antiviral therapy to treat COVID-19 by evaluating the relationship between comorbidities and hospitalization among US adolescents aged 12-17 with symptomatic coronavirus disease 2019 (COVID-19). The authors used the Pediatric COVID-19 US registry to identify patients who met their inclusion criteria of comorbidities including obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). Out of 1877 total patients included 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. The following comorbidities were associated with increased odds of hospitalization: SCD, immunocompromising condition, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma).
AHRQ-funded; HS000063.
Citation: Campbell JI, Dubois MM, Savage TJ .
Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019.
J Pediatr 2022 Jun;245:102-10.e2. doi: 10.1016/j.jpeds.2022.02.048..
Keywords: Children/Adolescents, Diabetes, Asthma, Kidney Disease and Health, Hospitalization
Bardach NS, Harder VS, McCulloch CE
Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization.
Researchers sought to assess the association between follow-up after an asthma-related emergency department (ED) visit and the likelihood of subsequent asthma-related ED utilization. Using data from California Medicaid, Vermont, and Massachusetts all-payer claims databases, they found a protective association between outpatient 14-day follow-up and asthma-related ED revisits. They suggested that this may reflect improved asthma control as providers follow the NHLBI guideline stepwise approach.
AHRQ-funded; HS025297; HS020518.
Citation: Bardach NS, Harder VS, McCulloch CE .
Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization.
Acad Pediatr 2022 Apr;22(3S):S125-S32. doi: 10.1016/j.acap.2021.10.015..
Keywords: Children/Adolescents, Asthma, Emergency Department, Respiratory Conditions, Healthcare Utilization
Cabana MD, Robinson K, Plavin J
Partnering to improve pediatric asthma quality.
The purpose of this article was to explore the need for partnering between emergency departments (Eds) and primary care physicians (PCPs) to improve asthma quality measures, practice level improvements for both PCPs and EDs, and ultimately improve outcomes for children with asthma. Proper and timely management of asthma is thought to prevent ED visits, and the responsibility for addressing improvements in PCP performance should be shared by the PCP practices and health care payors and plans. The ability to measure the drivers of asthma-related visits to the ED may be outside of what a PCP practice can address, and so practices must be able to partner with health plans to successfully measure and develop system-wide interventions for quality and outcomes improvement. Although a child’s asthma may be managed in their PCP office, treatment of asthma issues often takes place in an ED setting or urgent care clinic that may be completely isolated from the patient’s PCP provider and system. Health plans can fill in the missing pieces to provide feedback on performance which can reduce ED visits, improve medication adherence and management, and provide actionable and timely data about hospital visits and discharge to PCP practices for quality improvements. Social determinants and comorbidities play a role in addressing ED visits for asthma. Health plan, public health systems, and provider coordination, integration, and partnerships are required to effectively address those issues and improve outcomes. The authors conclude that a systems approach and thoughtful partnerships across disciplines will be required beyond the PCP practice level to improve the outcomes of children with asthma.
AHRQ-funded; HS025297.
Citation: Cabana MD, Robinson K, Plavin J .
Partnering to improve pediatric asthma quality.
Acad Pediatr 2022 Apr;22(3S):S73-S75. doi: 10.1016/j.acap.2021.06.013..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Emergency Department, Quality Measures, Quality Improvement, Quality of Care
Jaladanki S, Schechter SB, Genies MC
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
This study’s objective was to identify strategies associated with sustained guideline adherence and high-quality pediatric asthma care in community hospitals. Hospitals who were part of the Pathways for Improving Pediatric Asthma Care (PIPA) national quality improvement (QI) intervention were included. Clinicians (n = 19) involved in clinical care of children hospitalized with asthma were interviewed from five higher- and three lower-performing hospitals. Higher-performing hospitals had dedicated local champions who consistently provided reminders of evidence-based practices and delivered ongoing education. These champions also modified/developed electronic health record (EHR) tools. Lower-performing hospital clinicians described unique barriers, including delays in modifying the EHR and lack of automation of EHR tools. For all hospitals, barriers to sustainability included challenges with quality monitoring, decreasing focus of local champions over time, and ongoing difficulties developing around evidence-based practices.
AHRQ-funded; HS027041.
Citation: Jaladanki S, Schechter SB, Genies MC .
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
Health Serv Res 2022 Feb;57(1):125-36. doi: 10.1111/1475-6773.13870..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Hospitals, Quality of Care
Kan K, Shaunfield S, Kanaley M
Health provider perspectives of electronic medication monitoring in outpatient asthma care: a qualitative investigation using the consolidated framework for implementation research.
This study’s objective was to quantitatively explore the experience of health providers using electronic medication monitoring (EMM) in pediatric outpatient asthma care. The authors conducted interviews with 10 health providers using the Consolidated Framework of Implementation Research (CFIR) on their EMM experience with asthma patients from 5 primary care or specialty clinics. The EMM tracked albuterol and inhaled corticosteroid (ICS) use. Health providers called parents whenever ICS adherence waned, or albuterol use increased. The interviews were audio-recorded, transcribed, and deductively analyzed. Most providers felt the intervention improved care delivery, but implementation of the intervention model would require additional employees to handle the increased administrative and clinical workload.
AHRQ-funded; HS026385.
Citation: Kan K, Shaunfield S, Kanaley M .
Health provider perspectives of electronic medication monitoring in outpatient asthma care: a qualitative investigation using the consolidated framework for implementation research.
J Asthma 2022 Feb;59(2):342-51. doi: 10.1080/02770903.2020.1846745..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Ambulatory Care and Surgery
Schechter S, Jaladanki S, Rodean J
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
Community hospitals, which care for most hospitalised children in the USA, may be vulnerable to declines in paediatric care quality when quality improvement (QI) initiatives end. In this study, the investigators aimed to evaluate changes in care quality in community hospitals after the end of the Pathways for Improving Paediatric Asthma Care (PIPA) national QI collaborative. The investigators concluded that the end of the paediatric asthma QI collaborative was associated with concerning declines in guideline adherence in community hospitals.
AHRQ-funded; HS027041.
Citation: Schechter S, Jaladanki S, Rodean J .
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
BMJ Qual Saf 2021 Nov;30(11):876-83. doi: 10.1136/bmjqs-2020-012292..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Quality Improvement, Quality of Care
Nair AA, Farber HJ, Chen H
Utilization of opioid versus non-opioid analgesics in Medicaid and CHIP enrolled children with current asthma.
Opioid analgesics are frequently dispensed in children despite its known risk in children with a compromised airway function. The objectives of the study were to assess the prevalence of opioid analgesic dispensing in children with current asthma and to identify patient and prescriber factors associated with the dispensing of opioid versus non-opioid analgesics. The investigators concluded that opioid analgesics are frequently dispensed to children with asthma. A higher dispensing rate was observed among non-Hispanic White children and among those with a history of uncontrolled asthma.
AHRQ-funded; HS026790.
Citation: Nair AA, Farber HJ, Chen H .
Utilization of opioid versus non-opioid analgesics in Medicaid and CHIP enrolled children with current asthma.
Pharmacoepidemiol Drug Saf 2021 Nov;30(11):1520-31. doi: 10.1002/pds.5336..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Opioids, Medication, Asthma, Respiratory Conditions
Parikh K, Richmond M, Lee M
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
The purpose of this study was to evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program was conducted among children enrolled in K-8(th) grade on Medicaid hospitalized for an asthma exacerbation. The investigators concluded that the pilot data suggested that comprehensive care coordination initiated during the inpatient stay was feasible and acceptable.
AHRQ-funded; HS024554.
Citation: Parikh K, Richmond M, Lee M .
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
J Asthma 2021 Oct;58(10):1384-94. doi: 10.1080/02770903.2020.1795877..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Transitions of Care, Asthma, Hospital Discharge, Care Coordination, Chronic Conditions
Curry CW, Felt D, Kan K
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
Researchers sought to examine adjusted odds of non-remitting asthma by sexual identity, race/ethnicity, and their intersections, along with their relationship with traditional non-remitting asthma risk factors and victimization. Using data from the Youth Risk Behavior Survey, they found that, at the intersections, 8 sexual minority and racial/ethnic minority subpopulations were significantly more likely to have non-remitting asthma compared with White heterosexual sex-matched peers. They concluded that the evidence suggests that traditional non-remitting asthma risk factors and victimization may partly explain disparities in non-remitting asthma.
AHRQ-funded; HS026385.
Citation: Curry CW, Felt D, Kan K .
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
J Allergy Clin Immunol Pract 2021 Sep;9(9):3396-406. doi: 10.1016/j.jaip.2021.04.046..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Disparities
Joseph CLM, Alexander GL, Lu M
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
The authors piloted an electronic medical record-based tailored discussion guide (TDG) and a brief provider training to address weight management in overweight teens with asthma. They observed modest improvements in patient-reported asthma outcomes and health behaviors. They found strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. They recommended addressing challenges to recruitment and clinic adaptation prior to advancing to a full-scale trial.
AHRQ-funded; HS022417.
Citation: Joseph CLM, Alexander GL, Lu M .
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
Pilot Feasibility Stud 2021 Aug 30;7(1):167. doi: 10.1186/s40814-021-00848-6..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Asthma, Chronic Conditions, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Piwnica-Worms K, Staiger B, Ross JS
Effects of forced disruption in Medicaid managed care on children with asthma.
The objective of this study was to evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma. The investigators concluded that while there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.
AHRQ-funded; HS022882; HS025164.
Citation: Piwnica-Worms K, Staiger B, Ross JS .
Effects of forced disruption in Medicaid managed care on children with asthma.
Health Serv Res 2021 Aug;56(4):668-76. doi: 10.1111/1475-6773.13643..
Keywords: Children/Adolescents, Medicaid, Asthma, Respiratory Conditions, Chronic Conditions, Quality of Care
Schechter SB, Pantell MS, Parikh K
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
The objective of this study was to assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities. The investigators concluded that at baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care.
AHRQ-funded; HS026383; HS024554; HS024592.
Citation: Schechter SB, Pantell MS, Parikh K .
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
Acad Pediatr 2021 Aug;21(6):1018-24. doi: 10.1016/j.acap.2021.02.009..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Disparities, Quality Improvement, Quality of Care, Health Insurance
Turi KN, Gebretsadik T, Ding T
Dose, timing, and spectrum of prenatal antibiotic exposure and risk of childhood asthma.
The potential for prenatal antibiotic exposure to influence asthma risk is not clear. The investigators aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma. The investigators concluded that increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk.
AHRQ-funded; HS026395; HS018454.
Citation: Turi KN, Gebretsadik T, Ding T .
Dose, timing, and spectrum of prenatal antibiotic exposure and risk of childhood asthma.
Clin Infect Dis 2021 Feb 1;72(3):455-62. doi: 10.1093/cid/ciaa085.
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Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Antibiotics, Medication, Risk
Harder VS, Shaw JS, McCulloch CE
Statewide asthma learning collaborative participation and asthma-related emergency department use.
This study looked at outcomes from participation of pediatric practices in a quality improvement (QI) collaborative to decrease asthma-related emergency department (ED) visits. A statewide network of practices participated in the collaborative from 2015 to 2016. Asthma-related ED visit rates per 100 child-years for children ages 3 to 21 was evaluated using the state’s all-payer claims databases. The authors found that in the postintervention year (2017) participating practices’ ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years in non-participating practices. There were no statistically significant differences in asthma-related ED visit rates during 2016, which indicated that it took some time for QI elements to be successfully implemented in pediatric practices.
AHRQ-funded; HS025297.
Citation: Harder VS, Shaw JS, McCulloch CE .
Statewide asthma learning collaborative participation and asthma-related emergency department use.
Pediatrics 2020 Dec;146(6):e20200213. doi: 10.1542/peds.2020-0213..
Keywords: Children/Adolescents, Asthma, Emergency Department, Quality Improvement, Quality of Care, Primary Care, Guidelines
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Kaiser SV, Johnson MD, Walls TA
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
This quality improvement study’s aim was to determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs). Desired outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay. Charts were reviewed each month by EDs for children ages 2-17 years with a primary diagnosis of asthma. A total of 83 EDs were enrolled, with 37 of them children’s hospitals, and 46 community hospitals. Seventy-three percent completed the study (n = 22,963). There was a significant increase in systematic corticosteroid administration within 60 minutes of arrival as well as increased odds of severity assessment at triage and decreased rate of change in odds of hospital admission/transfer. Chest radiograph or ED length of stay was not associated with pathway implementation.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Johnson MD, Walls TA .
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
J Pediatr 2020 Aug;223:100-07.e2. doi: 10.1016/j.jpeds.2020.02.080..
Keywords: Children/Adolescents, Emergency Department, Asthma, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Kaiser SV, Lam Cabana, MD
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
The objective of this study was to identify potential best practices in pathway implementation. Building upon a previous observational study in which the researchers identified higher and lower performing children's hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway, they conducted semi-structured interviews with a sample of healthcare providers involved in pathway implementation at these hospitals. They identified several potential best practices to support pathway implementation. They recommended that hospitals implementing pathways consider applying these strategies to ensure success in improving quality of asthma care for children.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Lam Cabana, MD .
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
J Asthma 2020 Jul;57(7):744-54. doi: 10.1080/02770903.2019.1606237..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Inpatient Care, Guidelines, Evidence-Based Practice, Implementation, Quality Improvement, Quality of Care
Kaiser SV, Jennings B, Rodean J
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
This study examined whether implementation of a pathway strategy for inpatient pediatric asthma patients improve outcomes for these patients. Outcomes measured included length of stay (LOS), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits. Eighty-five hospitals were enrolled and 68 completed the study with (n=12,013) admissions. Pathways were associated with increases in early administration of metered-dose inhalers, and referral to smoking cessation resources, but no statistically significant changes in the other outcomes were observed. Most hospitals did improve in at least one outcome.
AHRQ-funded; HS024592; HS024554.
Citation: Kaiser SV, Jennings B, Rodean J .
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
Pediatrics 2020 Jun;145(6):e20193026. doi: 10.1542/peds.2019-3026..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Hospitalization, Care Management
Johnson MD, Zorc JJ, Nelson DS
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
Researchers examined the use, efficacy, and safety of intravenous magnesium sulfate (IVMg) in children with asthma whose emergency department (ED) management is recorded in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. They found that, in PECARN Registry EDs, administration of IVMg occurred late in ED treatment, for a minority of the children likely to benefit, with variation between sites, which suggested the current clinical role for IVMg in preventing hospitalization was limited. Discharge after IVMg administration would likely be safe. They recommended further research to assess the efficacy and safety of early IVMg administration.
AHRQ-funded; HS020270.
Citation: Johnson MD, Zorc JJ, Nelson DS .
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
J Pediatr 2020 May;220:165-74.e2. doi: 10.1016/j.jpeds.2020.01.062..
Keywords: Children/Adolescents, Asthma, Medication, Emergency Department, Registries, Treatments, Patient Safety, Medication: Safety