Implementation of Ontario’s emergency department asthma care pathway for adults: determinants of uptake

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.

Keywords:

• Epidemiology
• control/management

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.

Additional information

Funding

This study was funded by the Queen’s University William M. Spear Endowment/Start Memorial Fund. The Government of Ontario funded the Emergency Department Asthma Care Pathway development and province-wide dissemination. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI. M. Diane Lougheed and Jennifer Olajos-Clow participated in the development of the EDACP, and design and delivery of the implementation workshops. Carole Madeley was an employee of The Lung Association–Ontario, responsible for the pathway implementation workshops. Chanel Kwok, Linda Levesque, Yvonne DeWit, Jennifer Olajos-Clow, and Teresa To have no conflicts of interest to declare.