Journal article
Improving Quality of Acute Asthma Care in US Hospitals Changes Between 1999-2000 and 2012-2013
Chest, Vol.150(1), pp.112-122
07/01/2016
DOI: 10.1016/j.chest.2016.03.037
PMCID: PMC6026245
PMID: 27056585
Abstract
BACKGROUND: Little is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS).
METHODS: This study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 19992000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS.
RESULTS: The analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P < .001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (-14% [95% CI, -23 to -4]; P = .009).
CONCLUSIONS: Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.
Details
- Title: Subtitle
- Improving Quality of Acute Asthma Care in US Hospitals Changes Between 1999-2000 and 2012-2013
- Creators
- Kohei Hasegawa - Massachusetts General HospitalYusuke Tsugawa - Harvard UniversitySunday Clark - Cornell UniversityCarly D. Eastin - University of Arkansas for Medical SciencesSusan Gabriel - Novartis Pharmaceut, E Hanover, NJ USAVivian Herrera - Novartis Pharmaceut, E Hanover, NJ USAJane C. Bittner - Massachusetts General HospitalCarlos A. Camargo - Massachusetts General HospitalMARC-37 Investigators
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.150(1), pp.112-122
- DOI
- 10.1016/j.chest.2016.03.037
- PMID
- 27056585
- PMCID
- PMC6026245
- NLM abbreviation
- Chest
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Publisher
- Amer Coll Chest Physicians
- Number of pages
- 11
- Grant note
- Novartis Pharmaceuticals Corporation; Novartis University HealthSystem Consortium K23HL118151 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 07/01/2016
- Academic Unit
- Emergency Medicine
- Record Identifier
- 9984702825602771
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