TABLE 1

Study Descriptions for Included Articles (n = 30)

QI StrategyAuthorYearCountryStudy DesignAgeTotal ParticipantsSettingInterventionSelected Outcomes
Standardize careKelly et al172000United StatesRetrospective cohort studyMean age: 7.3 y149 childrenChildren’s Hospital of the King’s Daughters, Norfolk, VirginiaClinical pathway with pediatric asthma score and therapy-driven protocolLOS, total cost of care, ED visits, readmission
Standardize careJohnson et al182000United StatesRCT2–18 y110 childrenJohns Hopkins Hospital, Baltimore, MarylandClinical pathway with standardized nursing assessments for albuterol weaning protocolLOS, amount of albuterol received, acute care encounter at 2 wk postdischarge
Standardize careWazeka et al192001United StatesRetrospective, non-RCT2–18 y1210 childrenNew York Hospital Weill Cornell Medical Center, New York, New YorkClinical pathway with guidelines for the following: frequency of patient assessment, bronchodilator usage, corticosteroid usage, laboratory evaluation, vital signs, oxygen saturation, peak flow measurements, chest radiographs, social work involvement, and discharge planningLOS, cost per hospitalization (nursing, medication, laboratory, and radiology costs), relapse rate
Standardize careCunningham et al202008United KingdomCluster randomized trial2–16 y298 childrenRoyal Hospital for Sick Children, Edinburgh, United KingdomIntegrated care plan combines nursing, medical and clinical observations, and prescribing charts into single document; establishes discharge criteria, education, and asthma home management planRecovery of vital signs, quantity and speed of reduction of bronchodilator, time to fulfill discharge criteria, education provided
Standardize careBeck et al212012United StatesPre- and postdesign2–16 y546 childrenCincinnati Children’s Hospital, Cincinnati, OhioDesign and integrate electronic asthma-specific inpatient history and physical templateImproved documentation based on severity classification, use history, and environmental history
Standardize careZipkin et al222013United StatesPre- and postdesign2–17 y484 childrenChildren’s Hospital of Los Angeles, Los Angeles, CaliforniaInterventions included clinical care coordinator and electronic asthma home management planCAC-3 compliance
Standardize careKuhlmann et al232013United StatesInterrupted time series2–17 y336 childrenWesley Medical Center, Wichita, KansasInterventions included the following: revision of asthma home management plan to include 5 necessary elements, education of CAC, implementation of combined asthma home management plan with discharge medication reconciliation formCAC-3 compliance
Standardize careChong et al242016AustraliaCase-controlled pilot study1–16 y436 childrenPrincess Margaret Hospital for Children, Perth, Western AustraliaCLD initiated, which included tolerating albuterol every 3 h, >92% oxygen saturation for 4 h, no work of breathingLOS, readmission
Standardize careJassal et al252016United StatesPre- and postdesign2–21 y260 childrenJohns Hopkins Hospital, Baltimore, MarylandNew protocol with quantitative scoring system for respiratory therapy-driven weaning algorithmLOS, billing charges, readmission
EducationTaggart et al261991United StatesPre- and postdesign6–12 y40 childrenHospital ward in teaching hospital in Washington, District of ColumbiaSelf-management education program (written materials, videotapes, nurse discussion with patient)Patient knowledge and sense of personal control, use of medications for acute episodes, ED visits
EducationSmith et al272000ScotlandPre- and postdesign2–16 y232 childrenNinewells Hospital, Dundee, ScotlandHired dedicated asthma nurse educator to lead asthma education directed at clinicians, as well as discharge planning with patients and familiesAcute asthma management (beta-adrenergic agonist use, oxygen saturation check, oral steroid use, and peak flow check); discharge planning (inhaler technique assessment, prescriptions, self-management asthma education, follow-up)
EducationStevens et al28a2002United KingdomRCT18 mo–5 y200 childrenChildren’s Hospital, Leicester Royal Infirmary and Booth Hall Children’s Hospital, Manchester, United KingdomTwo 20-min long structured educational sessions with respiratory nurse and parent; provide preschool asthma booklet and written self-management planGP consultation rate, readmissions, ED visits
EducationNg et al29a2006ChinaRCT2–15 y100 childrenPublic hospital in Hong Kong; adult hospital with pediatrics wardsIntensive education program; 6 components: asthma nurse contact within 24 h of admission, colorful booklet with information and AAP, asthma diary, 20 min video, 30 min teaching session, skills assessment, phone follow-up 1 wk from discharge; required 2 h of nursing time, including 1 h extra from standard careED visits, readmissions, medication compliance, parent satisfaction
EducationEspinoza-Palma et al302009ChileRCT5–15 y88 childrenPediatrics ward, Dr Sotero del Rio Children’s Hospital, Santiago, ChileEducation without self-management plan compared with education with self-management planExacerbations, hospitalizations, ED visits, steroid courses
EducationDavis et al31a2011United StatesMatched cohort design>12 mo1396 childrenChildren’s Hospital and Research Center, Oakland, CaliforniaTrained respiratory professional provided 45 min of individualized bedside education and a follow-up phone call within 3 wk of discharge; self-management educational programED visit, readmissions
EducationMcCarty et al322012United StatesPre- and postdesignNANAInpatient setting, Children’s Hospital Boston, MassachusettsNurse-led program that educates caregivers that promote self-management; group education, but nurse educator follows up with families individually after group sessionParent satisfaction with education program, CAC-3 compliance
EducationRastogi et al332013United StatesRCT3–11268 caregivers of high health users for asthma careTertiary care teaching-hospital, New York City, New YorkCaregiver education sessionAsthma knowledge, ED visits, readmissions
EducationRice et al342015United StatesRCT2–17711 childrenSt Christopher’s Hospital for Children, Philadelphia, PennsylvaniaSelf-management educationAsthma specialty clinic follow-up, symptoms, self-efficacy scores at 1 mo follow-up interview
Discharge planningMarks et al35a1999AustraliaRCTMean age: 55.6 mo (SD: 37.2 mo)60 childrenRoyal Children’s Hospital, Melbourne, VictoriaCommunication with hospital and GP. GP telephoned during admission, GP and patient received printed information of discharge and post discharge care, patient with education booklets on asthma, follow-up appointments made for GPCommunication with GP, parental satisfaction, impairment of daily activities, school absenteeism, bronchodilator use, ED visit, readmissions
Discharge planningPoling36a2012United StatesRetrospective observational study2–18 y700 childrenWest and mid-western hospitalComparing standard CM model with more comprehensive CM modelLOS, readmission rate
Discharge planningBeck et al212013United StatesPre- and postdesign1–16 y562 childrenCincinnati Children’s Hospital Medical Center’s Liberty Campus, Cincinnati, OhioIdentify children with in-home risks (eg, pests, mold) and refer them for assessment and remediationRate of services offered to eligible patients, completed inspections, PMD notification of risks and referrals
Discharge PlanningSauers-Ford et al372016United StatesPre- and postdesign2.37 median y (IQR: 0.5–7.8)248 childrenCincinnati Children’s Hospital Medical Center’s Liberty Campus, Cincinnati, OhioPartnering with community pharmacies to provide medications in-hand at dischargeMedications in hand, discharged within 2 h of medical readiness, reuse
Discharge PlanningHatoun et al382016United StatesPre- and postdesign>2 y102 childrenBoston Medical Center, Boston, MassachusettsIn-hand medications with discharge medication delivery service. Outpatient pharmacist delivery of medications to inpatient room; medications in handMedications in hand, ED visits, readmission
MultimodalMadge et al39a1997ScotlandProspective randomized controlled study>2 y201 childrenRoyal Hospital for Sick Children, Glasgow, ScotlandNurse-led education program with discussion, written information, follow-up, and telephone advice to reinforce self-management plan; education and medications in hand (steroids for future exacerbation)Readmission, ED visits, asthma morbidity based on questionnaire 4 wk after discharge
MultimodalMcDowell et al40a1998United StatesNonrandomized prospective controlled trial1–18 y201 childrenRainbow Babies and Children’s Hospital, Cleveland, OhioAssessment-driven algorithm for inpatients to determine treatment and frequency of medications, criteria for ICU and discharge, specific education; standardize care + educationLOS, hospital charges per stay, readmission, need for acute care
MultimodalWesseldine et al41a1999United KingdomRCT2–16 y160 childrenDepartment of Child Health, University of Leicester, Leicester, United KingdomStructured discharge procedure for nursing, 20 min patient education and self-management plan for children; short course of oral steroids were offered; education and medications in handED visits, readmissions, GP consultations for asthma
MultimodalFassl et al42a2012United StatesPre- and postdesign2–17 y1865 childrenPrimary Children’s Medical Center, Salt Lake City, UtahEvidence-based care process model with decision support tools (includes standardized assessments of acute and chronic asthma severity and control, weaning protocols, criteria for specialist, ICU transfer, discharge criteria); standardize care and educationCAC-3 compliance, readmissions
MultimodalBergert et al43a2014United StatesPre- and postdesign2–18 y763 childrenKapi’olani Medical Center for Women and Children, Honolulu, HawaiiAsthma task force to increase CAC-1, -2, and -3 compliance and increase discharge follow-up, linking to medical home; standardize care and discharge planningCAC compliance, PMD follow-up, readmission, ED visits
MultimodalNkoy et al44a2015United StatesPre- and postdesign2–17 y5231 children8 hospitals: 1 tertiary care and 7 community (Intermountain Health System, Utah)Evidence-based care process model with decision support tools (includes standardized assessments of acute and chronic asthma severity and control, weaning protocols, criteria for specialist, ICU transfer, discharge criteria); standardize care and educationED visits, readmissions, LOS, costs, hospital resource use, ICU transfer after inpatient admission, death
MultimodalEkim and Ocakci45a2015TurkeyQuasi-experimental1–6 y120 childrenHospital-based pediatric respiratory clinic in IstanbulNurse-led discharge planning program; postdischarge included phone interview with parent (2 d postdischarge), telephone counseling for 3 mo, home visit 3 wk after discharge; education and discharge planningLevel of parent asthma management self-efficacy perception, ED visits, readmission, unscheduled outpatient visit
  • CLD, criteria-led discharge; CM, case management; GP, general practitioner; IQR, interquartile rage; NA, not applicable; PMD, primary medical doctor.

  • a Indicates studies included in the meta-analysis.