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住院儿童的护理之间存在显著差距。再住院率仍然很高，这与多种因素有关，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佳，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童哮喘EB护理流程模式(EB-CPM)的实施情况，同时我们将从一个学术医疗机构向城市和农村社区的犹他州医院传播EB-CPM。因哮喘住院的儿童是我们的目标人群(AHRQ的优先人群)。我们在德克萨斯州盐湖城的一家学术三级儿科医院-初级儿童医学中心(PCMC)开发并成功实施了跨越住院和过渡到门诊哮喘护理的EB-CPM，确立了EB-CPM在学术环境中的可行性。我们最近增加了一种新的策略，使用自我监控记分卡来优化动态哮喘护理，并降低急诊/住院再入院的风险。通过在不同的医院环境(类型、规模、位置、服务人口等)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机构。我们将通过以下具体目标实现我们的目标。目标1：在3所城市和3所农村社区医院实施EB-CPM。目的2：确定与6家社区医院和PCMC成功实施EB-CPM相关的组织因素。通过衡量提供者对哮喘急性和预防性质量措施的遵从性，确定EB-CPM实施的成功程度；对执行参与者进行半结构化调查，以确定与在这些设施中成功实施EB-CPM有关的组织因素。目的3：通过测量1)住院时间、2)费用和3)急诊/住院再住院率的变化来评估实施EB-CPM的影响。目的4：评估自我监测记分卡的使用在多大程度上改善入院后非卧床哮喘护理并减少急诊/住院再入院：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能力的认知；分析计分卡对门诊环境中严重程度适当的预防性药物的使用和急诊/医院再入院的相关影响。研究结果将促进儿童哮喘EB-CPM在全国其他山间保健机构和医疗机构的更广泛传播。广泛实施EB-CPM将大大改善哮喘护理的提供和结果，包括减少哮喘住院儿童的再入院。 公共卫生相关性：该项目的研究结果将促进儿童哮喘EB-CPM在区域和国家范围内的更广泛传播，并将为改善医院和出院后非卧床哮喘护理提供一种新的方法，从而减少哮喘相关儿童的再入院和费用。

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.