A Cost-Saving Algorithm for Children Hospitalized for Status Asthmaticus

McDowell, Karen M.; Chatburn, Robert L; Myers, Timothy R; O’Riordan, Mary Ann; Kercsmar, Carolyn M.

doi:10.1001/archpedi.152.10.977

Cited by 63 publications

(57 citation statements)

References 26 publications

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“…Previous studies have had relatively small sample sizes, selected cohorts, use of historical control subjects, or ignored the impact of such a program on healthcare costs (8)(9)(10)(11)(12)(13)(14)(15)(16). Some of these studies, but not all, have demonstrated a beneficial effect on healthcare use and asthma knowledge.…”

Section: Discussionmentioning

confidence: 99%

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Castro

Zimmermann

Crocker

et al. 2003

Am J Respir Crit Care Med

125

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The largest portion of the cost for asthma healthcare is due to hospitalizations. Improved methods of healthcare delivery for patients with asthma are needed to prevent readmissions. From 1996 to 1999, 96 adult subjects (predominantly young African American women) hospitalized with an asthma exacerbation, who had a history of frequent healthcare use, were randomized to an asthma nurse specialist intervention (n ϭ 50) or a usual care group (n ϭ 46) for 6 months. Our aim was to decrease rates of readmissions within 6 months of hospital discharge, to reduce cost, and to improve health-related quality of life. Our results demonstrate a 60% reduction in total hospitalizations (31 readmissions in the intervention group and 71 in the control group, p ϭ 0.04), with no significant change in emergency department visits. Readmissions for asthma were reduced by 54% (21 vs. 42 in the control group; p ϭ 0.04). We found a marked reduction in lost work or school days: 246 versus 1,040 days in the control group (p ϭ 0.02). The intervention resulted in a substantial reduction in direct and indirect healthcare costs, saving $6,462 per patient (p ϭ 0.03). A brief intervention program focusing on high healthcare users with asthma can result in improved asthma control and reduced hospital use with substantial cost savings.

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Section: Discussionmentioning

confidence: 99%

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Castro

Zimmermann

Crocker

et al. 2003

Am J Respir Crit Care Med

125

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show abstract

“…21 However, given that these types of hospitals are serving a disproportionately large share of medically complex and low-SES children, these hospitals should prioritize implementation of interventions shown to improve quality of care for children admitted with respiratory illness. Single-center studies have shown clinical pathways improve antimicrobial use 38 and reduce radiation exposure, video-assisted thoracoscopic surgery procedures, and readmission rates in children admitted for pneumonia 9 ; reduce resource utilization, [39][40][41] LOS, 41 and readmissions 8 in children admitted for bronchiolitis; and increase home asthma management teaching 7 and decrease in LOS 5,42 in children admitted for asthma. Larger, multicenter studies are needed to determine if clinical pathways are an effective means of improving quality of care for respiratory illnesses, and if pathways are found to be effective, policies should incentivize large, urban-teaching hospitals to implement pathways.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Kaiser

Bakel

Okumura

et al. 2015

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVES:Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). METHODS:Cross-sectional study of hospitalizations of patients ,18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (.90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions). RESULTS:

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“…Specifically, clinical pathways have been used as an effective strategy to improve compliance with use of peak flow meters, spacers, and prescribing of controller medications at the time of discharge [57][58][59][60]. Clinical pathways have also been shown to decrease length of stay and, therefore, costs associated with hospitalization.…”

Section: Clinical Pathwaysmentioning

confidence: 99%

Improving Asthma Care in the Hospital: an Overview of Treatments and Quality Improvement Interventions for Children Hospitalized for Status Asthmaticus

Kenyon

Auger

Adams

et al. 2014

Curr Treat Options Peds

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Asthma is one of the leading causes of pediatric hospitalization in the USA. This review summarizes evidence-based practices for inpatient pediatric asthma treatment, including routine care, care escalation, and discharge care, along with established and emerging inpatient quality improvement approaches. Intermittent inhaled beta agonists, systemic steroids, and, for patients with low oxygen saturation, supplemental oxygen remain the cornerstones of routine inpatient asthma care. Compared to nebulization, metered-dose inhaler delivery of intermittent beta agonist therapy is more effective and underused. Oral prednisone produces similar clinical outcomes and is more cost-effective when compared with intravenous methylprednisolone. Standardized respiratory assessment scores should supplement clinical judgment in evaluating response to therapy. There are no studies that demonstrate the effectiveness of routine adjuvant anticholinergic therapy outside of the emergency room, though it may be effective in a subset of inpatients. Evidence for inpatient care escalation is limited. With respect to discharge care, simple provision of asthma care plans does not appear to reduce readmissions, though individually tailored asthma care plans remain a standard of discharge care, along with systemic steroids, beta agonists, and, when indicated, inhaled corticosteroids. To avoid medication access barriers for high-risk patients, clinicians can ensure that discharge medications are in-hand before the patient leaves the hospital. A number of quality improvement strategies have shown promise in the inpatient setting. Clinical pathways reduce length of stay and costs associated with care without an associated increase in readmissions. Inpatient family education programs can be effective but should incorporate multiple strategies, including individualized management strategies and post-discharge follow-up. Inpatient care also serves as a useful opportunity to assess home environmental risk and to refer high-risk families to outpatient and community resources.

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A Cost-Saving Algorithm for Children Hospitalized for Status Asthmaticus

Abstract: To test the ability of an assessment-driven algorithm for treatment of pediatric status asthmaticus to reduce length and cost of hospitalization.

Cited by 63 publications

References 26 publications

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Improving Asthma Care in the Hospital: an Overview of Treatments and Quality Improvement Interventions for Children Hospitalized for Status Asthmaticus

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