Inpatient Asthma Care and Future Morbidity: A Role for Quality Improvement.

Abstract

* Abbreviations: ED — : emergency department QI — : quality improvement Children with asthma continue to suffer significant morbidity1 despite improved treatment options and widely distributed best practice guidelines.2 The best predictor of future severe asthma exacerbations is a recent asthma exacerbation.3,4 In “Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis” published this month in Pediatrics , Parikh et al5 examine the impact of quality improvement (QI) initiatives conducted during inpatient asthma hospitalization on future (postdischarge) asthma morbidity. After reviewing an array of inpatient asthma interventions, they used meta-analysis to conclude that inpatient QI efforts have limited impact on postdischarge asthma outcomes. Their findings reveal the paucity of programs directed at improving postdischarge asthma control. Importantly, they identify some positive outcomes after inpatient multimodal targeted asthma QI interventions. We applaud Parikh et al5 for conducting this ambitious analysis, especially given the wide range of interventions, methodologies, measured outcomes, and disparate care settings wherein asthma inpatient QI was conducted. We also congratulate them for evaluating whether inpatient QI work alone has short- or long-term effects on future asthma morbidity (ie, asthma-related emergency department [ED] revisits or readmissions). We suspect some think … Address correspondence to Elizabeth D. Allen, MD, Division of Pulmonary Medicine, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205. E-mail: beth.allen{at}nationwidechildrens.org