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ED acute asthma care quality differed by guideline recommendation

Changes in the quality of acute asthma care in United States EDs between 1997 and 2012 differed by level of guideline recommendation, as well as geographic location, according to recent study data.

Researchers analyzed data from three multicenter observational studies of adult patients aged 18 to 54 years with asthma exacerbation in 48 EDs. Two studies were conducted from 1997-2001 (n=2,119) and another study from 2011-2012 (n=1,920).

Objectives were to investigate changes in concordance of asthma exacerbation management in the EDs with 2007 NIH guidelines, to identify ED characteristics predictive of concordance and to determine if higher concordance was associated with lower risk for hospitalization for asthma. Item-by-item quality measures and composite concordance scores at the patient and ED levels (range, 0 to 100) were used to evaluate concordance with the guidelines.

“Over these 16 years, emergency asthma care became more concordant with level A recommendations at both the patient and ED levels (both P<.001),” the researchers wrote.

“By contrast, concordance with nonlevel A recommendations (peak expiratory flow measurement and timeliness) decreased at both patient (median score, 75 [IQR, 50-100] to 50 [IQR, 33-75], P<.001) and ED (mean score, 76 [SD, 7] to 50 [SD, 16], P<.001) levels.”

Southern and Western EDs demonstrated lower concordance compared with Midwestern EDs, according to multivariable analysis. Guideline concordant care was associated with reduced risk for hospitalization (OR=0.37; 95% CI, 0.26-0.53) when adjusted for severity.

“The observed improvement in the concordance with level A guideline recommendations supports prior optimism that the quality of emergency asthma care can be improved and morbidity reduced,” the researchers concluded. “By contrast, the decreased concordance with nonlevel A recommendations and wide interhospital variations in quality of care present an important challenge.

“Greater concordance with guideline-recommended management might reduce unnecessary hospitalizations.”

Disclosure: See the study for a full list of relevant disclosures.