Implementing Pathways to Improve Pediatric Asthma Care (PIPA)

Background: Asthma affects nearly 10% of American children, and is a leading cause of pediatric emergency visits and hospitalizations. Clinical pathways are operational versions of practice guidelines aimed at the hospital management of common illnesses. Single-site studies of pediatric asthma pathways have shown significant improvements in quality of care. Primary Objective: To evaluate the effectiveness of clinical pathways for improving quality of care for children with asthma in a diverse, national sample of emergency department (ED) and hospital settings. Primary Endpoints: Emergency Department: The proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival Inpatient/Hospital: Mean length of hospital stay Study Design: This project will be implemented through an established quality improvement collaborative of hospitals across the United States, the Value in Inpatient Pediatrics Network (part of the American Academy of Pediatrics). A cluster randomized design will be employed. Group 1 hospitals will receive a multifaceted implementation strategy that includes: 1) a pathway implementation toolkit, 2) local multidisciplinary champions in the ED and inpatient settings, 3) audit and feedback, 4) educational seminars, and 5) practice facilitation (via teleconference). Group 2 will receive the same intervention with the addition of a mobile app pathway tool.

Hospitals are in the control arm (usual care) after January 2017 until active implementation begins, which includes 3-6 months of implementation preparation (identifying local multidisciplinary champions, educational sessions/webinars for local champions, one teleconference with an external practice facilitator).

The PIPA intervention bundle 1 includes: Pathway Implementation Toolkit Local Multidisciplinary Champions Audit and Feedback Educational Seminars/Webinars Practice Facilitation

The PIPA intervention bundle 2 includes: Pathway Implementation Toolkit Local Multidisciplinary Champions Audit and Feedback Educational Seminars/Webinars Practice Facilitation Mobile App

Emergency Department: Proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival

Hospital/Inpatient: Proportion of children with administration of bronchodilator via metered-dose inhaler early in hospitalization

Hospital/Inpatient: Proportion of children who screen positive for secondhand tobacco smoke exposure whose caregivers are referred to smoking cessation resources

Hospital/Inpatient: Proportion of children with emergency department visits or readmissions to the hospital within 7 days

Emergency Department: Proportion of children who get an asthma exacerbation severity assessment at ED triage

Participant/Local champion Eligibility Criteria: Inclusion Criteria: Working as a physician at the study site Exclusion Criteria: None Patient/child eligibility criteria: Inclusion Criteria: Age 2-17 years Primary diagnosis of asthma Exclusion Criteria: Transferred in from another inpatient facility Presence of a chronic medical condition that precludes pathway use