Rising utilization of inpatient pediatric asthma pathways.
Rising utilization of inpatient pediatric asthma pathways.
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住院小儿哮喘途径的利用率不断提高。
DOI：
10.1080/02770903.2017.1316392
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
PediatricResearchinInpatientSettings(PRIS)Network
中科院分区：
文献类型：
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作者：
Kaiser,SunithaV;Rodean,Jonathan;Bekmezian,Arpi;Hall,Matt;Shah,SamirS;Mahant,Sanjay;Parikh,Kavita;Morse,Rustin;Puls,Henry;Cabana,MichaelD;PediatricResearchinInpatientSettings(PRIS)Network
简介：临床路径是详细的护理计划，将基于证据的指导方针转化为卫生服务提供者可访问的格式。他们的目标是将证据与实践联系起来，以优化患者的治疗结果和交付效率。目前尚不清楚住院儿童哮喘途径在全国范围内的应用程度。目的：(1)描述一个大型医院网络中住院儿童哮喘路径的设计和实施。(2)比较有无路径医院的特点。方法：我们对住院儿科研究网络中的医院（75%的儿童医院，25%的社区医院）进行了描述性、横断面调查研究。我们的调查确定了每家医院是否使用途径和途径特征（如途径要素、实施方法）。采用卡方检验（分类变量）和学生t检验（连续变量）对有无通路的医院进行比较。结果：每所医院向3-5名潜在参与者分发了调查问卷，302名（74%）参与者回应，占调查医院的86%（106/123）。从2005年到2015年，利用住院哮喘途径的医院比例从27%增加到86%。我们发现各医院在通路要素、实施策略、电子病历集成和合规监测方面存在差异。有路径的医院有更大的儿科住院项目[平均12.1对6.1全职等效，p= 0.04]，更常见的是独立儿童医院（52%对23%，p= 0.05）。结论：从2005年至2015年，住院儿童哮喘途径的实施急剧增加。我们在路径设计和实施的许多方面发现了差异。未来的研究应确定最佳的实施策略，以更好地支持医院在改善儿童哮喘护理和预后方面的努力。
Introduction: Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally.Objectives: (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways.Methods: We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables).Results: Surveys were distributed to 3–5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005–2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents,p= 0.04] and were more commonly free-standing children's hospitals (52% versus 23%,p= 0.05).Conclusions: From 2005–2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.