Oliver Kara, Xu Chen Xilei, Wooldridge Jamie, Kumar Brinda Prasanna, Sunuwar Lalina, Eng Samantha, Swatski Matthew, Hamilton Daniel, Perez Geovanny F
From the Department of Pediatrics, Division of Hospitalist Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, N.Y.
Department of Pediatrics, Division of Pulmonology and Sleep Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, N.Y.
Pediatr Qual Saf. 2025 Aug 13;10(6):e829. doi: 10.1097/pq9.0000000000000829. eCollection 2025 Sep-Oct.
Asthma is the most common chronic illness in pediatrics, placing a significant burden on patients and the healthcare system. The lack of standardization in screening, diagnosis, and treatment remains a key challenge in pediatric asthma management. This project used the Project BREATHE toolkit, supplied through the New York State Department of Health, to implement a care process for children with asthma receiving care at our institution. Our primary objective was to enhance asthma care through a quality improvement framework to optimize outcomes and reduce healthcare usage.
Following identifying key drivers contributing to suboptimal asthma care in our region, our transdisciplinary team developed a standardized asthma care process. From July 2020 to June 2021, the process was systematically applied to all patients admitted with a diagnosis of asthma. Control charts were reviewed monthly to assess adherence and uptake of care process components, facilitating continuous quality improvement and data-driven modifications.
Following implementation, inhaled corticosteroid prescriptions increased from 50% to 81%, whereas subspecialist consults rose from 8.3% to 77%. The proportion of patients receiving asthma severity assessments ranged from 71% to 90%, and the rates of asthma education fluctuated from 50% to 89%. Additionally, the rate of emergency department visits declined from 5.2% to 4.7% and hospitalizations from 12.7% to 10.1% following implementation.
Implementing a transdisciplinary asthma care process resulted in sustained improvements in asthma management and reduced asthma-related emergency department visits and hospitalizations. These findings highlight the effectiveness of a structured, team-based approach in optimizing pediatric asthma care.
哮喘是儿科最常见的慢性病,给患者和医疗系统带来了沉重负担。在儿科哮喘管理中,筛查、诊断和治疗缺乏标准化仍是一个关键挑战。本项目使用了通过纽约州卫生部提供的“呼吸项目”工具包,为在我们机构接受治疗的哮喘儿童实施一种护理流程。我们的主要目标是通过质量改进框架加强哮喘护理,以优化治疗效果并减少医疗资源的使用。
在确定了导致我们地区哮喘护理欠佳的关键驱动因素后,我们的跨学科团队制定了标准化的哮喘护理流程。从2020年7月到2021年6月,该流程被系统地应用于所有诊断为哮喘的住院患者。每月审查控制图,以评估护理流程各组成部分的依从性和采用情况,促进持续质量改进和基于数据的调整。
实施后,吸入性糖皮质激素处方率从50%提高到81%,而专科会诊率从8.3%提高到77%。接受哮喘严重程度评估的患者比例在71%至90%之间,哮喘教育率在50%至89%之间波动。此外,实施后急诊就诊率从5.2%降至4.7%,住院率从12.7%降至10.1%。
实施跨学科哮喘护理流程使哮喘管理得到持续改善,并减少了与哮喘相关的急诊就诊和住院。这些发现突出了结构化、基于团队的方法在优化儿科哮喘护理方面的有效性。