Journal article
Hospital-Initiated Care Bundle, Posthospitalization Care, and Outcomes in Adults with Asthma Exacerbation
The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.9(11), pp.4007-4013.e8
11/2021
DOI: 10.1016/j.jaip.2021.06.044
PMID: 34265445
Abstract
Hospitalization for asthma exacerbation is an opportune setting for initiating preventive efforts. However, hospital-initiated preventive asthma care remains underdeveloped and its effectiveness is uncertain.
To examine the effectiveness of a hospital-initiated asthma care bundle on posthospitalization asthma care and clinical outcomes.
Prospective multicenter study of adults (18-54 years) hospitalized for asthma exacerbation in 2017 to 2019. During the hospitalization, we implemented an asthma-care bundle (inpatient laboratory testing, asthma education, and discharge care), and prospectively measured chronic asthma care (eg, immunoglobulin E testing, specialist care) and asthma exacerbation (ie, systemic corticosteroid use, emergency department [ED] visit, hospitalizations) outcomes. By applying a self-controlled case series method, we examined within-person changes in these outcomes before (2-year period) and after (1-year period) the bundle implementation.
Of 103 adults hospitalized for asthma exacerbation, the median age was 40 years and 72% were female. Compared with the preimplementation period, the postimplementation period had improved posthospitalized asthma care, including serum specific immunoglobulin E testing (rate ratio [RR] 2.18; 95% confidence interval [95% CI] 0.99-4.84; P = .051) and evaluation by asthma specialist (RR 2.66; 95% CI 1.77-4.04; P < .001). Likewise, after care bundle implementation, patients had significantly lower annual rates of systemic corticosteroid use (4.2 vs 2.9 per person-year; RR 0.70; 95% CI 0.61-0.80; P < .001), ED visits (3.2 vs 2.7 per person-year; RR 0.83; 95% CI 0.72-0.95; P = .008), and hospitalizations (2.1 vs 1.8 per person-year; RR 0.82; 95% CI 0.69-0.97; P = .02). Stratified analyses by sex, race and ethnicity, and health insurance yielded consistent results.
After hospital-initiated care bundle implementation, patients had improved posthospitalization care and reduced rates of asthma exacerbation.
Details
- Title: Subtitle
- Hospital-Initiated Care Bundle, Posthospitalization Care, and Outcomes in Adults with Asthma Exacerbation
- Creators
- Makiko Nanishi - Massachusetts General HospitalValerie G. Press - University of Chicago Medical CenterJoseph B. Miller - Henry Ford HospitalCarly Eastin - University of Arkansas for Medical SciencesTaruna Aurora - Virginia Commonwealth University Medical CenterErin Crocker - Harvard UniversityMichimasa Fujiogi - Massachusetts General HospitalCarlos A. Camargo - Massachusetts General HospitalKohei Hasegawa - Massachusetts General Hospital
- Resource Type
- Journal article
- Publication Details
- The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.9(11), pp.4007-4013.e8
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jaip.2021.06.044
- PMID
- 34265445
- ISSN
- 2213-2198
- eISSN
- 2213-2201
- Grant note
- Novartis Pharmaceuticals Corporation (https://doi.org/10.13039/100008272) Novartis (https://doi.org/10.13039/100004336) Massachusetts General Hospital (https://doi.org/10.13039/100005294)
- Language
- English
- Date published
- 11/2021
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984702944002771
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