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Inpatient asthma care may benefit from standardized, personal care plans
Data published in Pediatrics suggest that inpatient asthma care may benefit from standardization that utilizes personalized care plans, as asthma heterogeneity and care practices significantly vary.
“The Ohio Pediatric Asthma Repository (OPAR) is a unique and innovative resource that links the six Ohio children’s hospitals with the goal of improving the health of children with asthma,” study researcher Jocelyn M. Biagini Myers, PhD, of Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “The long-term objective is to identify the practices and phenotypes associated with the best health outcomes so that best practices can be implemented across these hospitals and similar hospitals across the United States.”
Jocelyn M. Biagini
OPAR participants were hospitalized at Cincinnati Children’s Hospital Medical Center, Nationwide Children’s Hospital, Dayton Children’s Hospital, Akron Children’s Hospital, University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, and ProMedica Toledo Children’s Hospital.
Researchers assessed participants aged 2 to 17 years admitted for asthma, wheezing or reactive airway disease (n = 1,012).
The use of magnesium, intramuscular epinephrine, albuterol spacing and asthma pathway utilization in the ED varied across all hospitals (P < .0001 for all). Specifically, magnesium was administered to more than 30% of participants in Cincinnati and Akron compared with less than 6% at Toledo and Dayton. Further, all hospitals except Cincinnati and Columbus reported regularly using an ED asthma pathway.
Admission source, ICU admittance, ipratropium administration, short-acting beta agonist administration and provider type varied across the hospitals (P < .0001 for all), despite all sites reportedly using an inpatient standardized care pathway.
Albuterol spacing for discharge (P < .0001), oral steroids (P < .0001), inhaled corticosteroids prescribed (P = .0035), scheduled follow-up appointments (P < .0001) and post-discharge telephone calls (P < .0001) also varied across all study sites.
Classification of asthma severity varied at the hospitals (P = .006), however, when dichotomized as intermittent/mild or moderate/severe, the variability was not significant.
Length of stay varied (P < .0001), ranging from 58.1 hours in Cleveland to 24.5 hours in Dayton.
The only significant association between asthma risk and clinical practices was found between patients with moderate/severe asthma severity classification and prescribed inhaled corticosteroids (OR = 2.7; 95% CI, 1.6-4.5).
“The degree of variability in the clinical practices observed was somewhat unexpected,” Biagini Myers and colleagues wrote. “These variations in practice are certainly due, in part, to the severity of the individual exacerbation, but are also likely due to institutional policy differences.”
The OPAR is an ongoing project that will continue to compare ED, inpatient and discharge practices alongside patient demographics, exposures and asthma severity to determine practices that lead to the best clinical outcomes across all hospitals.
“These data will better define asthma phenotypes, identify best care practices while avoiding unnecessary variation in care practices, as well as inform personalized care plans to reduce reutilization and readmission for asthma,” Biagini Myers and colleagues concluded. – by Amanda Oldt
Disclosure: Biagini Myers reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
