Improving Quality of Acute Asthma Care in US Hospitals

Hasegawa, Kohei; Tsugawa, Yusuke; Clark, Sunday; Eastin, Carly; Gabriel, Stuart A.; Herrera, Vivian; Bittner, Jane C.; Camargo, Carlos A.; Ahn, Jason; Aurora, Taruna; Brenner, Barry E.; Brown, Mark A.; Calhoun, William J.; Gough, John E.; Gharib, Asal; Heidt, Jonathan; Khosravi, Mehdi; Moore, Wendy C.; Mould‐Millman, Nee‐Kofi; Nonas, Stephanie; Nowak, Richard M.; Pei, Veronica; Press, Valerie G.; Probst, Beatrice D.; Ramratnam, Sima; Tallar, Matthew; Teuber, Suzanne S.; Trent, Stacy A.; Villarreal, Roberto; Watase, Taketo; Youngquist, Scott T.

doi:10.1016/j.chest.2016.03.037

Cited by 17 publications

(7 citation statements)

References 32 publications

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“…Compared to seasonal influenza, COVID-19 has been associated with a higher risk of mechanical ventilator use (hazard ratio [HR] 4.01, confidence interval [CI]: 3.53–4.54) and ICU admission (HR 2.41, CI: 2.25–2.59) [ 4 ], and a prolonged length of hospital stay (mean [SD],10 [10.99] days vs. 7 [19.00] days; median (IQR) range of hospital stay, 6 [ 3 – 12 ] to 8 [ 4 – 16 ] days vs. 3 [ 2 – 6 ] to 4 [ 2 – 7 ] days) [ 4 , 52 ]. The median (IQR) length of hospital stay for patients with acute asthma has been estimated at 2 (1–3) days [ 53 ]. The mean (SD) range of length of hospital stay for adults hospitalized with acute COPD exacerbation has been reported at 4.5 (3.3) to 6 days, and up to 16 (16.7) days for ICU admissions [ 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

et al. 2021

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The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

et al. 2021

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“…Although national asthma treatment guidelines have proven useful in standardizing care approaches and improving outcomes, 8, 9 there is increasing recognition of phenotypic heterogeneity in patients with asthma that is particularly marked in those with severe disease. Given recent mandates for more personalized and more efficient medicine, “precision medicine” for patients with severe asthma is needed; particularly since the existing evidence base for severe asthma care is quite limited.…”

Section: Introductionmentioning

confidence: 99%

Severe Asthma Phenotypes — How Should They Guide Evaluation and Treatment?

Fitzpatrick

Moore

2017

The Journal of Allergy and Clinical Immunology: In Practice

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108

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Although patients with “severe” asthma tend to be characterized by ongoing symptoms and airway inflammation despite treatment with high doses of inhaled and systemic corticosteroids, there is increasing recognition of marked phenotypic heterogeneity within affected patients. While “precision medicine” approaches for patients with severe asthma are needed, there are many hurdles that must be overcome in daily practice. The National Heart, Lung and Blood Institute's Severe Asthma Research Program (SARP) has been at the forefront of phenotype discovery in severe asthma for the past decade. SARP, along with other international groups, have described clinical severe asthma phenotypes in both adults and children that can be evaluated in the clinical setting. While these clinical phenotypes provide a good “starting point” for addressing disease heterogeneity in severe asthma in everyday practice, more efforts are needed to understand how these phenotypes relate to underlying disease mechanisms and pharmacological treatment responses. This review highlights the clinical asthma phenotypes identified to date, their associations with underlying endotypes and potential biomarkers, and remaining knowledge gaps that must be addressed before precision medicine can become a reality for patients with severe asthma.

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“…Treating obstructive bronchitis and acute asthma requires monitoring oxygen saturation and providing oxygen supplementation if needed; administering inhaled short‐acting beta‐agonists and sometimes rehydration . The drugs usually work well and the required treatment periods are typically short, with a median of 2 days . Treating bronchiolitis requires monitoring oxygen saturation and breathing work and hospitalised infants often need oxygen and fluid support .…”

Section: Discussionmentioning

confidence: 99%

“…19 The drugs usually work well and the required treatment periods are typically short, with a median of 2 days. 20 Treating bronchiolitis requires monitoring oxygen saturation and breathing work and hospitalised infants often need oxygen and fluid support. 2,3,21 In a previous study, invasive ventilator support, which substantially increases direct and indirect costs, was needed in 11% of bronchiolitis patients who received intensive care.…”

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confidence: 99%

Nursing intensity scores did not correlate well with reimbursement claims for infant bronchiolitis

et al. 2019

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Aim We retrospectively evaluated the hospital reimbursement rates for inpatient bronchiolitis treatment and then compared them to the RAFAELA® nursing intensity scores. Methods We selected all 44 bronchiolitis patients treated in the paediatric intensive care unit (PICU) and then for each PICU‐treated patient two patients treated on the ward (n = 88) under 12 months of age in 2010‐2015. The data included medical histories, hospital reimbursement rates using the Nordic Diagnosis Related Groups (NordDRG) or expense categories and the RAFAELA® scores. Results Reimbursement claims were mostly based on expense categories for PICU admissions and NordDRG categories for ward admissions. The median (range) was €6352 (€1330‐30 554) and €2009 (€768‐6027) per episode for the PICU and ward cases, respectively. The median lengths of hospital stay were 8.5 days (3‐18) and 3 days (1‐8), respectively. Higher RAFAELA® scores were associated with nasal continuous positive airway pressure therapy and mechanical ventilation in the PICU and oxygen supplementation and nasogastric tube feeding on the ward. The correlation coefficients between RAFAELA® scores and hospital reimbursement claims ranged from 0.121‐0.450. Conclusion Hospital reimbursement claim for a PICU admission was three times as much as a ward admission and reimbursement claims for bronchiolitis did not match with nursing intensity scores.

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Improving Quality of Acute Asthma Care in US Hospitals

Abstract: Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.

Cited by 17 publications

References 32 publications

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

Severe Asthma Phenotypes — How Should They Guide Evaluation and Treatment?

Nursing intensity scores did not correlate well with reimbursement claims for infant bronchiolitis

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