Measuring the Quality of Inpatient Care for Asthma

Abstract

Hospital Care| March 01 2009 Measuring the Quality of Inpatient Care for Asthma AAP Grand Rounds (2009) 21 (3): 30. https://doi.org/10.1542/gr.21-3-30 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Measuring the Quality of Inpatient Care for Asthma. AAP Grand Rounds March 2009; 21 (3): 30. https://doi.org/10.1542/gr.21-3-30 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: asthma, inpatients Source: Nkoy FL, Fassl BA, Simon TD, et al. Quality of care for children hospitalized with asthma. Pediatrics. 2008;122(5):1055–1063; doi:10.1542/peds.2007–2399 In this retrospective, observational study researchers from Primary Children’s Medical Center in Salt Lake City developed evidence-based measures of quality for the inpatient management of asthma, and evaluated rates of compliance with these measures at their institution. Utilizing systematic methodologies to review the literature and develop expert consensus, the research team identified 43 potential measures of quality. Of these, a consensus panel selected nine final measures that were evidence-based, feasible, and could be reliably assessed using chart review. The nine final quality measures evaluated specific medical decisions or attributes of the processes of care for asthma in the hospital. Clinical outcomes were not measured directly, but were assumed to be linked to the quality measures based on support from the medical literature. Compliance with the identified measures was rated utilizing retrospective chart review of children 2–17 years of age discharged from the hospital with a primary diagnosis of asthma exacerbation during 2005. The medical records of 252 patients were reviewed. Provider compliance with quality measures specific to acute inpatient management of asthma included: documentation of asthma severity at admission, 39%; use of systemic corticosteroid therapy, 98%; use of oral, not intravenous, corticosteroid, 87%; use of ipratropium bromide limited to the first 24 hours after admission, 71%; and use of metered-dose inhaler rather than nebulizer for children >5 years of age, 20%. Provider compliance with these measures was higher than compliance with the four measures related to preventing re-exacerbation and readmission: documentation of chronic asthma severity, 22%; parental participation in asthma education class, 33%; provision of a written asthma action plan, 5%; and scheduled follow-up with the primary care provider at discharge, 22%. This research team identified nine potential determinants of quality of care for children hospitalized with asthma. Variable and low compliance with these measures suggests that emphasizing and monitoring these measures may lead to improvements in the quality of inpatient care for these patients. Dr. Pate has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This study has important limitations, many of which are discussed comprehensively by the authors. Two deserve special attention. First, the study may have been subject to bias in the selection of patients, the selection of final quality measures, and the description of institutional compliance with the measures. Second, due to the chart review methodology, several important indicators of quality of asthma care were not included in the group of final measures. Taken together, these limitations weaken the implied association between the nine measures and overall quality of clinical outcomes in asthma care for hospitalized patients. Measuring specific medical decisions, documentation, and processes as determinants of quality is attractive because these endpoints may be easier to measure than clinical outcomes. However, in order to maximize the value of this intermediate focus, we must demonstrate a... You do not currently have access to this content.