Abstract
Objective
The Ontario Government funded the development and implementation of a standardized adult emergency department (ED) asthma care pathway (EDACP). We aimed to describe baseline patterns of ED use by adults for asthma in Ontario, Canada, and determine site characteristics associated with the EDACP implementation workshop attendance and subsequent pathway implementation.
Methods
All Ontario EDs were offered EDACP implementation workshops by the Lung Assocation-Ontario between 2008 and 2011, and were surveyed regarding site implementation status as of October, 2013. Survey data were linked by site to Ontario’s administrative health databases. Logistic regression models investigated the association between site and patient characteristics and: a) workshop attendance; b) pathway implementation.
Results
In the 2 years prior to EDACP implementation, there were 41 143 asthma visits to 167 sites by adults (62.3% female). Asthma-related return visits within 72 h varied by hospital type (teaching 2.1%, community 2.8%, small 4.0%; p < 0.05). Implementation workshops were attended by staff from 122 sites (72.6%). Implementation status was known for 108 sites and varied by hospital type (p < 0.001), but not workshop attendance (p = 0.11). By 2013, 47% of all hospitals were using or planning to use the EDACP. Uptake was more likely in community hospitals.
Conclusions
Ontario adult asthma ED visitors are more often women. Asthma-related return visits are uncommon, but significantly higher in small community hospitals. This provincial QI initiative reached almost 75% of Ontario EDs, and achieved almost 50% implementation rate within 2 years. Factors other than workshop attendance, such as hospital size, were associated with EDACP implementation.
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Declaration of interest
The authors alone are responsible for the content and writing of the paper.
In the past 3 years, M. Diane Lougheed has received grants outside the submitted work paid directly to Queen’s University from The Lung Association-Ontario, Ontario Thoracic Society, the Government of Ontario’s Innovation Fund, AllerGen NCE, Queen's University, GlaxoSmithKline, AstraZeneca, Hoffman LaRoche, Janssen, and Novartis, honoraria from the The Lung Association-Ontario and the Canadian Thoracic Society for preparation and review of educational materials, and honoraria from AstraZeneca for participation in the Precision Program Advisory Board.