Hogan Alexander H, Rastogi Deepa, Rinke Michael L
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut; and
Children's Hospital at Montefiore, Bronx, New York, New York.
Hosp Pediatr. 2018 Mar;8(3):127-134. doi: 10.1542/hpeds.2017-0184. Epub 2018 Feb 13.
Our objective was to investigate if a rigorous quality improvement (QI) intervention could increase accuracy of pediatric asthma controller medications on discharge from an inpatient hospitalization.
Our interprofessional QI team developed interventions such as improving documentation and creating standardized language to ensure patients were discharged on an appropriate asthma controller medication and improve assessment of asthma symptom control. Each week of 2015-2016, the first 5 patients discharged with status asthmaticus from the pediatric wards were reviewed for documentation of the 6 asthma control questions and accuracy of the discharge controller therapy. Correct discharge medication was defined as being prescribed the age-appropriate medication and dose on the basis of baseline controller therapy, compliance with baseline medication, and responses to asthma control assessment. The weekly proportion of control questions that were accessed and correct controller medications that were prescribed were analyzed by using Nelson rules and interrupted time series.
A total of 240 preintervention and 252 postintervention charts were reviewed. The primary outcome of the median proportion of patients discharged on appropriate controller therapy improved from 60% in preintervention data to 80% in the postintervention period. The process measure of proportion of asthma control questions that were assessed improved from 43% in the preintervention period to 98% by the final months of the intervention period. Both of these changes were statistically significant as per Nelson's rules and interrupted time series analyses ( = .02 and < .001, respectively, for postintervention break).
An interdisciplinary QI team successfully improved the accuracy of asthma controller therapy on discharge and the inpatient assessment of asthma control questions.
我们的目的是调查一项严格的质量改进（QI）干预措施能否提高小儿哮喘控制药物在住院患者出院时的准确性。
我们的跨专业QI团队制定了干预措施，如改进文档记录和创建标准化语言，以确保患者出院时使用适当的哮喘控制药物，并改善对哮喘症状控制的评估。在2015 - 2016年的每周，对小儿病房首批5例哮喘持续状态出院的患者进行6个哮喘控制问题的文档记录以及出院控制治疗准确性的审查。正确的出院药物定义为根据基线控制治疗、基线药物依从性和哮喘控制评估反应开出适合年龄的药物和剂量。使用纳尔逊规则和中断时间序列分析每周访问的控制问题比例和开出的正确控制药物比例。
共审查了240份干预前和252份干预后的病历。主要结局指标，即出院时接受适当控制治疗的患者中位数比例从干预前数据中的60%提高到干预后期的80%。哮喘控制问题评估比例这一过程指标从干预前期的43%提高到干预后期最后几个月的98%。根据纳尔逊规则和中断时间序列分析，这两个变化均具有统计学意义（干预后断点分别为P = .02和P < .001）。
一个跨学科QI团队成功提高了出院时哮喘控制治疗的准确性以及住院患者哮喘控制问题的评估。
