Effectiveness of Pediatric Asthma Pathways for Hospitalized Children: A Multicenter, National Analysis

Pediatric Research in Inpatient Settings (PRIS) Network

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. Study design: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. Results: Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. Conclusions: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.

Original languageEnglish (US)
Pages (from-to)165-171.e2
JournalJournal of Pediatrics
Volume197
DOIs
StatePublished - Jun 2018
Externally publishedYes

Fingerprint

Hospitalized Child
Critical Pathways
Ipratropium
Length of Stay
Asthma
Bronchodilator Agents
Pediatrics
Anti-Bacterial Agents
Multicenter Studies
Thorax
Steroids
Health Information Systems
Hospital Costs
Child Care
Inpatients
Cohort Studies
Databases
Costs and Cost Analysis

Keywords

  • clinical pathways

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Effectiveness of Pediatric Asthma Pathways for Hospitalized Children : A Multicenter, National Analysis. / Pediatric Research in Inpatient Settings (PRIS) Network.

In: Journal of Pediatrics, Vol. 197, 06.2018, p. 165-171.e2.

Research output: Contribution to journalArticle

Pediatric Research in Inpatient Settings (PRIS) Network. / Effectiveness of Pediatric Asthma Pathways for Hospitalized Children : A Multicenter, National Analysis. In: Journal of Pediatrics. 2018 ; Vol. 197. pp. 165-171.e2.
@article{76fbc8a64c3145fdb055af1b12191677,
title = "Effectiveness of Pediatric Asthma Pathways for Hospitalized Children: A Multicenter, National Analysis",
abstract = "Objective: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. Study design: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. Results: Clinical pathway implementation was associated with an 8.8{\%} decrease in LOS (95{\%} CI 6.7{\%}-10.9{\%}), 3.1{\%} decrease in hospital costs (95{\%} CI 1.9{\%}-4.3{\%}), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. Conclusions: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.",
keywords = "clinical pathways",
author = "{Pediatric Research in Inpatient Settings (PRIS) Network} and Kaiser, {Sunitha V.} and Jonathan Rodean and Arpi Bekmezian and Matt Hall and Shah, {Samir S.} and Sanjay Mahant and Kavita Parikh and Auerbach, {Andrew D.} and Rustin Morse and Puls, {Henry T.} and McCulloch, {Charles E.} and Cabana, {Michael D.}",
year = "2018",
month = "6",
doi = "10.1016/j.jpeds.2018.01.084",
language = "English (US)",
volume = "197",
pages = "165--171.e2",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Effectiveness of Pediatric Asthma Pathways for Hospitalized Children

T2 - A Multicenter, National Analysis

AU - Pediatric Research in Inpatient Settings (PRIS) Network

AU - Kaiser, Sunitha V.

AU - Rodean, Jonathan

AU - Bekmezian, Arpi

AU - Hall, Matt

AU - Shah, Samir S.

AU - Mahant, Sanjay

AU - Parikh, Kavita

AU - Auerbach, Andrew D.

AU - Morse, Rustin

AU - Puls, Henry T.

AU - McCulloch, Charles E.

AU - Cabana, Michael D.

PY - 2018/6

Y1 - 2018/6

N2 - Objective: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. Study design: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. Results: Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. Conclusions: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.

AB - Objective: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. Study design: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. Results: Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. Conclusions: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.

KW - clinical pathways

UR - http://www.scopus.com/inward/record.url?scp=85044131156&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044131156&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2018.01.084

DO - 10.1016/j.jpeds.2018.01.084

M3 - Article

C2 - 29571931

AN - SCOPUS:85044131156

VL - 197

SP - 165-171.e2

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -