Open AccessPredictors of Quality Improvement in Pediatric Asthma Care
Author(s) -
Sunitha V. Kaiser,
Nisha Gupta,
Joanne Mendoza,
Gabriella Azzarone,
Kavita Parikh,
Joanne Nazif,
Adithya Cattamanchi
Publication year - 2020
Publication title -
hospital pediatrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 20
eISSN - 2154-1663
pISSN - 2154-1671
DOI - 10.1542/hpeds.2020-0163
Subject(s) - medicine , asthma , emergency medicine , triage , inhaler , audit , referral , quality management , emergency department , family medicine , medical emergency , nursing , management system , management , economics
BACKGROUND: Little is known about what hospital and emergency department (ED) factors predict performance in pediatric quality improvement efforts. OBJECTIVES: Identify site characteristics and implementation strategies associated with improvements in pediatric asthma care. METHODS: In this secondary analysis, we used data from a national quality collaborative. Data on site factors were collected via survey of implementation leaders. Data on quality measures were collected via chart review of children with a primary diagnosis of asthma. ED measures included severity assessment at triage, corticosteroid administration within 60 minutes, avoidance of chest radiographs, and discharge from the hospital. Inpatient measures included early administration of bronchodilator via metered-dose inhaler, screening for tobacco exposure, and caregiver referral to smoking cessation resources. We used multilevel regression models to determine associations between site factors and changes in mean compliance across all measures. RESULTS: Sixty-four EDs and 70 inpatient units participated. Baseline compliance was similar by site characteristics. We found significantly greater increases in compliance in EDs within nonteaching versus teaching hospitals (12% vs 5%), smaller versus larger hospitals (10% vs 4%), and rural and urban versus suburban settings (6%–7% vs 3%). In inpatient units, we also found significantly greater increases in compliance in nonteaching versus teaching hospitals (36% vs 17%) and community versus children’s hospitals (23% vs 14%). Changes in compliance were not associated with organizational readiness or number of audit and feedback sessions or improvement cycles. CONCLUSIONS: Specific hospital and ED characteristics are associated with improvements in pediatric asthma care. Identifying setting-specific barriers may facilitate more targeted implementation support.