A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits.
| Autor: | Hersey SJ; Division of Primary Care Pediatrics., Retzke J; Division of Primary Care Pediatrics., Allen ED; Professor Emeritus, The Ohio State University College of Medicine, Columbus, Ohio., Snyder D; Division of Primary Care Pediatrics., Hardy C; Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio., Groner J; Division of Primary Care Pediatrics. |
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| Jazyk: | angličtina |
| Zdroj: | Pediatrics [Pediatrics] 2023 Dec 01; Vol. 152 (6). |
| DOI: | 10.1542/peds.2023-061355 |
| Abstrakt: | Background and Objectives: Asthma exacerbation is a common and often preventable cause of Emergency Department (ED) utilization. Children eligible for Medicaid are at increased risk of poor asthma control and subsequent ED visits. In 2010, we implemented a multicomponent longitudinal quality improvement project to improve pediatric asthma care for our primary care population, which was 90% Medicaid-eligible. Our goal was to reduce asthma-related ED visits by patients ages 2 to 18 years by 3% annually. Methods: The setting was a multisite large urban high-risk primary care network affiliated with a children's hospital. We implemented 5 sequential interventions within our network of pediatric primary care centers to increase: use of asthma action plans by clinicians, primary care-based Asthma Specialty Clinic visits (extended asthma visits in the main primary care site), use of a standard asthma note at all visits, documentation of the Asthma Control Test, and step-up therapy for children with poorly controlled asthma. Results: At baseline in 2010, there were 21.7 asthma-related ED visits per 1000 patients per year. By 2019, asthma-related ED visits decreased to 14.5 per 1000 patients per year, a 33% decrease, with 2 center line shifts over time. We achieved and sustained our goal metrics for 4 of 5 key interventions. Conclusions: We reduced ED utilization for asthma in a large, high-risk pediatric population. The interventions implemented and used over time in this project demonstrate that sustainable outcomes can be achieved in a large network of primary care clinics. (Copyright © 2023 by the American Academy of Pediatrics.) |
| Databáze: | MEDLINE |
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