Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. 1055-1063 (doi:10.1542/peds.2007-2399)
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ARTICLE

Quality of Care for Children Hospitalized With Asthma

Flory L. Nkoy, MD, MS, MPH, Bernhard A. Fassl, MD, Tamara D. Simon, MD, MSPH, Bryan L. Stone, MD, Rajendu Srivastava, MD, FRCP(C), MPH, Per H. Gesteland, MD, MS, Gena M. Fletcher, MS and Christopher G. Maloney, MD, PhD, FAAP

Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah

OBJECTIVES. The goals were (1) to identify evidence-based clinical process measures that are appropriate, feasible, and reliable for assessing the quality of inpatient asthma care for children and (2) to evaluate provider compliance with these measures.

METHODS. Key asthma quality measures were identified by using a modified Rand appropriateness method, combining a literature review of asthma care evidence with a consensus panel. The feasibility and reliability of obtaining these measures were determined through manual chart review. Provider compliance with these measures was evaluated through retrospective manual chart review of data for 252 children between 2 and 17 years of age who were admitted to a tertiary care children's hospital in 2005 because of asthma exacerbations.

RESULTS. Nine appropriate, feasible, reliable, clinical process measures of inpatient asthma care were identified. Provider compliance with these measures was as follows: acute asthma severity assessment at admission, 39%; use of systemic corticosteroid therapy, 98%; use of oral (not intravenous) systemic corticosteroid therapy, 87%; use of ipratropium bromide restricted to <24 hours after admission, 71%; use of albuterol delivered with a metered-dose inhaler (not nebulizer) for children >5 years of age, 20%; documented chronic asthma severity assessment, 22%; parental participation in an asthma education class, 33%; written asthma action plan, 5%; scheduled follow-up appointment with the primary care provider at discharge, 22%.

CONCLUSIONS. Nine appropriate, feasible, reliable, clinical process measures of inpatient asthma care were identified. Provider compliance across these measures was highly variable but generally low. Our study highlights opportunities for improvement in the provision of asthma care for hospitalized children. Future studies are needed to confirm these findings in other inpatient settings.

Key Words: asthma • pediatrics • inpatient care • quality of care • quality measures • provider compliance

Abbreviations: ED—emergency department • PCMC—Primary Children's Medical Center • RCT—randomized, controlled trial

Accepted Feb 29, 2008.


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