Implementing pediatric inpatient asthma pathways

Abstract

Objective

Pathways are succinct, operational versions of evidence-based guidelines. Studies have demonstrated pathways improve quality of care for children hospitalized with asthma, but we have limited information on other key factors to guide hospital leaders and clinicians in pathway implementation efforts. Our objective was to evaluate the adoption, implementation, and reach of inpatient pediatric asthma pathways.

Methods

This was a mixed-methods study of hospitals participating in a national collaborative to implement pathways. Data sources included electronic surveys of implementation leaders and staff, field observations, and chart review of children ages 2-17 years admitted with a primary diagnosis of asthma. Outcomes included adoption by hospitals, pathway implementation factors, and reach of pathways to children hospitalized with asthma. Quantitative data were analyzed using descriptive statistics and multivariable regression. Qualitative data were analyzed using thematic content analysis.

Results

Eighty-five hospitals enrolled; 68 (80%) adopted/completed the collaborative. These 68 hospitals implemented pathways with overall high fidelity, implementing a median of 5 of 5 core pathway components (Interquartile Range [IQR] 4-5) in a median of 5 months (IQR 3-9). Implementation teams reported a median time cost of 78 h (IQR: 40-120) for implementation. Implementation leaders reported the values of pathway implementation included improvements in care, enhanced interdisciplinary collaboration, and access to educational resources. Leaders reported barriers in modifying electronic health records (EHRs), and only 63% of children had electronic pathway orders placed.

Conclusions

Hospitals implemented pathways with high fidelity. Barriers in modifying EHRs may have limited the reach of pathways to children hospitalized with asthma.

Keywords:

• Asthma
• child
• clinical pathway
• quality improvement

Acknowledgements

We would like to acknowledge AAP staff and all the local PIPA implementation leaders that made this study possible.

Financial disclosures

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

Dr. Cabana has consultancy positions with Biogaia AB, Novartis, and Phadia, and acts as a review panel member for Genentech. The other authors have indicated they have no potential conflicts of interest to disclose.

Additional information

Funding

This study had no external funding. Drs. Kaiser and Parikh are supported by career development grants from the Agency for Healthcare Research and Quality (K08HS024592 and K08HS024554) but this agency played no role in the design, data collection, analysis, or reporting of this study.