In a national quality improvement intervention (QI), researchers have outlined several strategies for sustainable, high-quality care for children with asthma, including designating long-term local champions to continue reminders and educational efforts and developing electronic ordering sets to provide ongoing decision support. to offer.
The team, led by Sarah B. Schechter, MD, Department of Pediatrics, University of California, believed that prioritizing these strategies would also lead to higher returns on QI investments.
Schechter and colleagues cited “critical knowledge gaps” in the prevention of long-term, high-quality hospital care for children with asthma, as well as US hospital admissions (100,000 hospitalizations for children with asthma per year) and total direct costs (~$1.6 billion) .
Prior to the study, there were no previous studies focusing on children in community hospitals.
In this qualitative study, the aim was to study selected community hospitals to identify strategies associated with ongoing, high-quality pediatric asthma care.
Schechter and colleagues collected data from a national QI intervention called Pathways for Improving Pediatric Asthma Care (PIPA), which was led by the Value in Inpatient Pediatrics Network, the inpatient QI network of the American Academy of Pediatrics.
The intervention involved 85 hospitals, 45 of which were community hospitals.
From there, the participating hospitals were divided into 2 groups. Half of all sites started in January 2018 and the other half started in April 2018.
The QI intervention focused on evidence-based practices such as early bronchodilator administration via metered dose inhalers, screening for secondhand tobacco exposure and referral to smoking cessation resources, as well as shortening recovery time and/or hospitalization.
From there, researchers interviewed PIPA implementation leaders and other pediatric community hospital clinicians with the highest sustainability performance in sustainability strategies.
PIPA implementation leaders from 5 higher performing and 3 lower performing community hospitals participated in the study. A total of 19 participants were interviewed.
Higher achievers were defined by no significant performance reductions at/after the end of the QI intervention, and long-term improvements in >2 of the 4 outcome measures (n=5 hospitals).
Lower achievers were defined as those with a reduction of >3 out of 4 outcome measures after the end of the QI intervention, and no significant long-term improvements (n=3 hospitals).
Researchers identified 3 promising strategies used by community hospitals with higher performance in pediatric QI endurance, but were unusual or inconsistent in lower performance hospitals.
Better-performing hospitals had designated local champions who consistently continued to use two strategies after the end of the QI intervention, continuously providing reminders of evidence-based practices and educating about evidence-based pediatric asthma care.
These hospitals also adapted/developed EHR tools that remained available to support clinicians after the QI intervention ended, while underperforming sites reported inability to develop/adapt EHR tools, significant delays in these processes and /or lack of automation of EHR tools.
Despite the fact that most community hospitals do not have a robust infrastructure for pediatric QI, the study by Schechter and colleagues confirmed the effectiveness and sustainability of these strategies.
The better-performing hospitals in this study reported using these strategies for two years during and after the QI intervention, indicating long-term feasibility, and in their previous survey of 104 hospitals participating in a national pediatric QI intervention. , the team found the most sites supported local champions, reminders of fact-based practices, and electronic orders.
“To increase feasibility, QI leaders should proactively plan to pursue such strategies in the long term and initiate this planning at the beginning of QI interventions,” the team wrote. “Future studies are also needed to prospectively test the effectiveness of these and other potential strategies and quantify the associated costs.”
The study, “Strategies for Sustaining High-quality Pediatric Asthma Care in Community Hospitals,” was published online in Health Services Research.