Organizational Factors Associated with Improved Inpatient Pediatric Asthma Care

描述（由申请人提供）：最佳哮喘护理实践的证据与为住院儿童提供的护理之间存在显著差距。再入院率仍然很高，并且与多种因素相关，包括1）提供者不遵守循证（EB）哮喘预防措施，2）医院后护理过渡执行不力，以及3）患者不遵守哮喘家庭治疗。我们将进行一项研究，以评估一个成功的儿科哮喘EB护理过程模型（EB-CPM）的实施，因为我们将EB-CPM从一个学术医疗机构传播到犹他州城市和农村社区的医院。哮喘住院儿童是我们的目标人群（AHRQ优先人群）。 我们开发并成功实施了EB-CPM，其跨越住院和过渡到门诊哮喘护理的学术三级护理儿科医院-初级儿童医疗中心（PCMC），湖城，UT，建立EB-CPM在学术环境中的可行性。我们最近增加了一个新的策略，使用自我监测记分卡，以优化门诊哮喘护理和降低艾德/再入院的风险。通过在不同的医院环境（类型、规模、位置、服务人群等）中实施EB-CPM，我们将能够确定与成功实施EB-CPM相关的关键组织因素，这些因素可以推广到全国其他设施。我们将通过以下具体目标实现我们的目标。 目标1：在3个城市和3个农村社区医院实施EB-CPM。目标2：确定与成功实施EB-CPM在6个社区医院和PCMC相关的组织因素：2.a.通过测量提供者对急性哮喘和预防性质量措施的依从性来确定EB-CPM实施的成功;以及2.b.对实施参与者进行半结构化调查，以确定与这些设施成功实施EB-CPM相关的组织因素。目标3：通过测量1）住院时间、2）费用和3）艾德/再入院率的变化，评价实施EB-CPM的影响。目标4：评价自我监测记分卡的使用在多大程度上改善了住院后的非卧床哮喘护理并减少了艾德/再入院：4.a.调查患者/家长对记分卡的使用情况以及他们对哮喘自我管理技能的感知;以及4.b.分析记分卡对在门诊环境中使用严重程度适当的预防性药物和艾德/再入院的相关影响。研究结果将促进儿科哮喘EB-CPM在全国其他Intermountain Healthcare机构和医疗机构的更广泛传播。EB-CPM的广泛实施将大大改善哮喘护理服务和结果，包括减少哮喘住院儿童的再入院率。 公共卫生相关性：该项目的研究结果将促进儿童哮喘EB-CPM在地区和全国范围内的更广泛传播，并将提供一种新的方法来改善住院和出院后的门诊哮喘护理，从而减少儿童哮喘相关的再入院和费用。

DESCRIPTION (provided by applicant): A significant gap exists between the evidence for best asthma care practices and the care provided to hospitalized children. Readmission rates remain high and are associated with multiple factors including 1) provider non-compliance with evidence-based (EB) asthma preventive measures, 2) poorly executed post- hospital care transitions, and 3) patient non-compliance with asthma home therapy. We will, conduct a study to evaluate the implementation of a successful pediatric asthma EB care process model (EB-CPM) as we disseminate the EB-CPM from an academic medical facility to Utah hospitals in urban and rural communities. Children hospitalized with asthma are our target population (an AHRQ priority population). We developed and successfully implemented an EB-CPM that spans inpatient and transition to ambulatory asthma care at an academic tertiary care pediatric hospital-Primary Children's Medical Center (PCMC), Salt Lake City, UT, establishing the feasibility of the EB-CPM in an academic setting. We recently added a novel strategy using a self-monitoring scorecard to optimize ambulatory asthma care and decrease the risk for ED/hospital readmissions. By implementing the EB-CPM in different hospital settings (types, size, location, population served, etc), we will be able to identify critical organizational factors associated with successful implementation of the EB-CPM that can be generalized to other facilities nationwide. We will achieve our objectives through the following Specific Aims. Aim 1: Implement the EB-CPM at 3 urban and 3 rural community hospitals. Aim 2: Determine organizational factors associated with successful implementation of the EB-CPM at 6 community hospitals and PCMC: 2.a. determine the success of the EB-CPM implementation by measuring provider compliance with asthma acute and preventive quality measures; and 2.b. conduct semi-structured surveys of implementation participants to identify organizational factors associated with successful implementation of the EB-CPM across these facilities. Aim 3: Evaluate the impact of implementing the EB-CPM by measuring change in 1) hospital length of stay, 2) cost, and 3) ED/hospital readmission rates. Aim 4: Evaluate the extent to which use of the self-monitoring scorecard improves post-hospitalization ambulatory asthma care and reduces ED/hospital readmissions: 4.a. survey patients/parents about their use of the scorecard and their perceived self-management skills about asthma; and 4.b. analyze the associated impact of the scorecard on use of severity appropriate preventive medications in ambulatory settings and on ED/hospital readmission. Study results will facilitate broader dissemination of the pediatric asthma EB-CPM at other Intermountain Healthcare facilities and medical facilities nationwide. Broad implementation of the EB-CPM will result in major improvement in asthma care delivery and outcomes including reduced readmissions for children hospitalized with asthma. PUBLIC HEALTH RELEVANCE: Findings from this project will facilitate broader dissemination of the pediatric asthma EB-CPM regionally and nationally, and will provide a novel approach for improving both hospital and post-discharge ambulatory asthma care, thereby reducing asthma-associated readmissions and costs in children.