Effects of a standardized Emergency Department asthma care pathway on health services utilization

Abstract

Background: An evidence-based standardized emergency department (ED) asthma care pathway (EDACP) was developed and implemented in Ontario, Canada. Objective: We sought to determine the impact of EDACP implementation on hospital admissions and return ED visits. Methods: 167 Ontario hospitals were surveyed regarding their EDACP implementation date and status as of August 2017. Using provincial health administrative data, a Poisson regression interrupted time series analysis was conducted. Results: Of the 123 (73.7%) hospitals responding to the survey, 44 (35.8%) had an approved EDACP. Nine sites were excluded due to unreported implementation date or insufficient follow-up data. Data were analyzed for the 5 years preceding (30,028 visits) and 17 months following (7,916 visits) implementation, with a 3-month implementation black-out period. Regression analysis showed that after controlling for auto-regressive factors, EDACP implementation was associated with a 2% reduction in return ED visits within 72 hours (p=0.0124), and within 7 days (p=0.0295) at teaching hospitals (Figure 1). The same effect was not seen at community hospitals. There was no significant effect on hospital admissions. Conclusions: While ED practice patterns varied across the province, the study findings support an overall positive effect of implementing an evidence-based standardized adult asthma pathway on reducing return ED visits for asthma.