Summary

A Clinical Practice Improvement study was conducted at 10 pediatric hospitals throughout the US to determine areas of significant improvement in the treatment of pediatric asthma patients. The analyses in this study formed the basis for the development of research-based dynamic protocols that identify process steps associated with better outcomes for pediatric asthma patients. Data were collected on 762 asthma patients.

Primary Objective

Methods

Data were collected on 762 pediatric asthma patients. Multivariate analyses were performed on all data.

Results

1.      After controlling for age, gender, severity of illness, atelectasis in two or more lobes, esophageal reflux, oxygen therapy, and inhaled asthma medications before admission, longer length of stay was associated with use of antibiotics in older children, use of aminophylline/ theophylline, use of Ipratropium bromide, continuously nebulized albuterol for more than three hours, intubation, switching from IV to oral steroids, and chest physiotherapy.

2.      After controlling for age, gender, severity of illness, atelectasis in two or more lobes, esophageal reflux, oxygen therapy, and inhaled asthma medications before admission, higher costs were associated with all of the treatment variables in number 1 above, as well as use of Midazolan (Versed).

Impact

Extensive variation in practice was found across all 10 pediatric hospitals regardless of severity of illness.  If the best practices were used in all our study institutions we would expect on average a 0.5 day decrease in length of stay and a $1,679 decrease in cost per case.