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Slade IR, Beck SJ, Kramer CB, Symons RG, Cusumano M, Flum DR, Gallagher TH, Devine EB. Communication Training, Adverse Events, and Quality Measures: 2 Retrospective Database Analyses in Washington State Hospitals. J Patient Saf 2021; 17:e393-e400. [PMID: 28671907 DOI: 10.1097/pts.0000000000000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Washington State's HealthPact program was launched in 2011 as part of AHRQ's Patient Safety and Medical Liability Reform initiative. HealthPact delivered interdisciplinary communication training to health-care professionals with the goal of enhancing safety. We conducted 2 exploratory, retrospective database analyses to investigate training impact on the frequency of adverse events (AEs) and select quality measures across 3 time frames: pretraining (2009-2011), transition (2012), and posttraining (2013). METHODS Using administrative data from Washington State's Comprehensive Hospital Abstract Reporting System (CHARS) and clinical registry data from the Surgical Care and Outcomes Assessment Program (SCOAP), we compared proportions of AEs and quality measures between HealthPact (n = 4) and non-HealthPact (n = 93-CHARS; n = 48-SCOAP) participating hospitals. Risk ratios enabled comparisons between the 2 groups. Multivariable logistic regression enabled investigation of the association between training and the frequency of AEs. RESULTS Approximately 9.4% (CHARS) and 7.7% (SCOAP) of unique patients experienced 1 AE or greater. In CHARS, the odds of a patient experiencing an AE in a HealthPact hospital were initially (pretraining) higher than in a non-HealthPact hospital (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.10-1.17), lower in transition (OR, 0.80; 95% CI, 0.76-0.83) and posttraining (OR, 0.72; 95% CI, 0.69-0.75) periods. In SCOAP, ORs were consistently lower in HealthPact hospitals: pretraining (OR, 0.87; 95% CI, 0.80-0.95), transition (OR, 0.75; 95% CI, 0.70-0.81), and posttraining (OR, 0.63; 95% CI, 0.58-0.68). The proportion of at-risk patients that experienced each individual AE was low (<1%) throughout. Adherence to quality measures was high. CONCLUSIONS Interprofessional communication training is an area of intense activity nationwide. A broad-based training initiative may play a role in mitigating AEs.
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Affiliation(s)
- Ian R Slade
- From the Department of Anesthesiology and Pain Medicine
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Pinto JM, Navallo LJ, Petrova A. Does participation in the community outreach for asthma care and healthy lifestyles (COACH) program alter subsequent use of hospital services for children discharged with asthma? J Asthma 2019; 58:231-239. [PMID: 31566040 DOI: 10.1080/02770903.2019.1672719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Transition from hospital to home is a challenging time for children with asthma and their caregivers because of the high risk for reutilization of acute hospital services. Detecting effective quality improvement initiatives to reduce utilization of urgent services in children discharged with asthma is an important clinical and public health question. This study was designed to identify the role of a multimodal, nurse-driven, inpatient initiated Community Outreach for Asthma Care and Healthy lifestyles (COACH) program on subsequent use of hospital services for pediatric patients with asthma.Methods: We utilized comparative effectiveness design to identify the difference in recurrent emergency department (ED) visits and/or admissions within 12-months after discharge between patients with asthma who engaged in the COACH program (Intervention group) and those who did not (Comparison group). We used administrative databases of hospitals included in the Meridian Health system to identify the number of and time to asthma-related readmissions and ED re-attendances.Results: We found no difference in the rate or number of recurrent hospital-based services used within 12 months, but found a reduction in ED re-visitation and/or readmission within 30 days for COACH program participants prior to and after adjustment for age, race/ethnicity, insurance status, and clinical presentation (Odd Ratio 0.44, 95% Confidence Interval 0.20, 0.93).Conclusion: Participation in the COACH program decreases the likelihood for subsequent use of hospital services within a month of discharge for children with asthma. Enhanced post-discharge interactions with families may reduce long-term reuse of hospital-based services for COACH program participants.
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Affiliation(s)
- Jamie M Pinto
- Hackensack-Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA.,Hackensack-Meridian Health School of Medicine, Nutley, NJ, USA
| | - Lauren J Navallo
- Hackensack-Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Anna Petrova
- Hackensack-Meridian Health, Jersey Shore University Medical Center, Neptune, NJ, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Lo HY, Messer A, Loveless J, Sampayo E, Moore RH, Camp EA, Macias CG, Quinonez R. Discharging Asthma Patients on 3-Hour β-Agonist Treatments: A Quality Improvement Project. Hosp Pediatr 2018; 8:733-739. [PMID: 30385459 DOI: 10.1542/hpeds.2018-0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of hospital protocols and national guidelines, little guidance is available regarding appropriate short-acting β-agonist (SABA) frequency discharge criteria. Our aim was to reduce the median length of stay (LOS) for children hospitalized with asthma exacerbations by 4 hours by changing the discharge requirement SABA frequency. METHODS Multiple plan-do-study-act cycles based on findings in our key driver diagram were used to decrease LOS. Our primary intervention was reducing the SABA administration frequency discharge requirement from every 4 hours to every 3 hours. After a feasibility pilot, this change was implemented throughout the hospital. Our intervention bundle included updating our evidence-based guidelines, electronic health record order sets and note templates, house-wide education, and a new process for respiratory therapists to notify physicians of discharge readiness. Our primary metric was LOS, with 3-, 7-, and 14-day same-cause emergency department (ED) revisits and hospital readmissions as balancing metrics. Statistical process control charts and nonparametric testing were performed for data analysis. RESULTS Median hospital LOS was significantly lower in the postintervention period compared with the preintervention period (30.18 vs 36.14 hours respectively; P < .001). Statistical process control charts indicated special cause variation was achieved. No significant differences were observed in rates of ED revisits or hospital readmissions. CONCLUSIONS Reducing the discharge requirement of SABA frequency from every 4 hours to every 3 hours resulted in a reduction in LOS, with no increase in ED recidivism or hospital readmission rates.
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Affiliation(s)
| | - Amanda Messer
- Pediatric Hospital Medicine, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, Louisiana
| | | | | | | | - Elizabeth A Camp
- Section of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Charles G Macias
- Evidence-Based Outcomes Center.,Section of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; and
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Grinspan ZM, Patel AD, Hafeez B, Abramson EL, Kern LM. Predicting frequent emergency department use among children with epilepsy: A retrospective cohort study using electronic health data from 2 centers. Epilepsia 2017; 59:155-169. [DOI: 10.1111/epi.13948] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Zachary M. Grinspan
- Department of Healthcare Policy and Research; Weill Cornell Medicine; New York NY USA
- Department of Pediatrics; Weill Cornell Medicine; New York NY USA
- New York Presbyterian Hospital; New York NY USA
| | | | - Baria Hafeez
- Department of Healthcare Policy and Research; Weill Cornell Medicine; New York NY USA
| | - Erika L. Abramson
- Department of Healthcare Policy and Research; Weill Cornell Medicine; New York NY USA
- Department of Pediatrics; Weill Cornell Medicine; New York NY USA
- New York Presbyterian Hospital; New York NY USA
| | - Lisa M. Kern
- Department of Healthcare Policy and Research; Weill Cornell Medicine; New York NY USA
- New York Presbyterian Hospital; New York NY USA
- Department of Medicine; Weill Cornell Medicine; New York NY USA
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Hamburger R, Berhane Z, Gatto M, Yunghans S, Davis RK, Turchi RM. Evaluation of a statewide medical home program on children and young adults with asthma. J Asthma 2015; 52:940-8. [PMID: 25539026 DOI: 10.3109/02770903.2014.999282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma, the most common chronic condition among children, accounts for significant healthcare utilization and impact on quality of life. Care coordination in a medical home is considered standard practice, but has not been rigorously evaluated. METHODS We initiated this pilot study of children/young adults with asthma (n = 967), ages: birth to 24 years, receiving care from a subset of pediatric practices (n = 20) participating in the Pennsylvania Medical Home Initiative, Educating Practices in Community-Integrated Care (92 practices statewide). We hypothesized children and youth with asthma receiving care coordination in the context of a formal medical home program would experience favorable associations with healthcare utilization and quality of life measures. RESULTS A total of 9240 care coordination encounters for this cohort of children/youth occurred over 100 days. The average length of care coordination encounter was 20.7 minutes. The most common care coordination activity was referral management (21%) and the care coordinator in the practice most often contacted parent/family and specialists (75%). Children with more severe asthma had more hospitalizations and emergency department (ED) visits than children with less severe asthma. There was a significant decrease in school absences, ED visits and acute care visits for children/youth with asthma with increasing length of time in a medical home program (p < 0.05). CONCLUSION Care coordination for children/youth with asthma is feasible and may yield improvements in healthcare utilization, expenditures and quality of life. Larger-scale implementation of care coordination and medical home models for children/youth with asthma and other diagnoses are warranted.
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Affiliation(s)
- Robert Hamburger
- a Nova Southeastern University College of Osteopathic Medicine , Fort Lauderdale , FL , USA .,b Department of Epidemiology and Biostatistics , School of Public Health, Drexel University , Philadelphia , PA , USA
| | - Zekarias Berhane
- b Department of Epidemiology and Biostatistics , School of Public Health, Drexel University , Philadelphia , PA , USA
| | - Molly Gatto
- c Make-A-Wish Foundation of Philadelphia and Susquehanna Valley , Blue Bell , PA , USA
| | - Suzanne Yunghans
- d Pennsylvania Chapter, American Academy of Pediatrics , Media , PA , USA
| | - Renee K Davis
- e Department of Community Health and Prevention , Maternal and Child Health Working Group, School of Public Health, Drexel University , Philadelphia , PA , USA
| | - Renee M Turchi
- e Department of Community Health and Prevention , Maternal and Child Health Working Group, School of Public Health, Drexel University , Philadelphia , PA , USA .,f Department of Pediatrics , St. Christopher's Hospital for Children , Philadelphia , PA , USA , and.,g Department of Community Health and Prevention , School of Public Health, Drexel University , Philadelphia , PA , USA
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Children and Adults With Frequent Hospitalizations for Asthma Exacerbation, 2012-2013: A Multicenter Observational Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:751-8.e1. [PMID: 26028297 DOI: 10.1016/j.jaip.2015.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/02/2015] [Accepted: 05/05/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Earlier studies reported that many patients were frequently hospitalized for asthma exacerbation. However, there have been no recent multicenter studies to characterize this patient population with high morbidity and health care utilization. OBJECTIVE To examine the proportion and characteristics of children and adults with frequent hospitalizations for asthma exacerbation. METHODS A multicenter chart review study of patients aged 2 to 54 years who were hospitalized for asthma exacerbation at 1 of 25 hospitals across 18 US states during the period 2012 to 2013 was carried out. The primary outcome was frequency of hospitalizations for asthma exacerbation in the past year (including the index hospitalization). RESULTS The cohort included 369 children (aged 2-17 years) and 555 adults (aged 18-54 years) hospitalized for asthma exacerbation. Over the 12-month period, 36% of the children and 42% of the adults had 2 or more (frequent) hospitalizations for asthma exacerbation. Among patients with frequent hospitalizations, guideline-recommended outpatient management was suboptimal. For example, among adults, 32% were not on inhaled corticosteroids at the time of index hospitalization and 75% had no evidence of a previous evaluation by an asthma specialist. At hospital discharge, among adults with frequent hospitalizations who had used no controller medications previously, 37% were not prescribed inhaled corticosteroids. Likewise, during a 3-month postdischarge period, 64% of the adults with frequent hospitalizations were not referred to an asthma specialist. Although the proportion of patients who did not receive these guideline-recommended outpatient care appeared higher in adults, these preventive measures were still underutilized in children; for example, 38% of the children with frequent hospitalizations were not referred to asthma specialist after the index hospitalization. CONCLUSIONS This multicenter study of US patients hospitalized with asthma exacerbation demonstrated a disturbingly high proportion of patients with frequent hospitalizations and ongoing evidence of suboptimal longitudinal asthma care.
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Auger KA, Kahn RS, Davis MM, Simmons JM. Pediatric asthma readmission: asthma knowledge is not enough? J Pediatr 2015; 166:101-8. [PMID: 25241184 DOI: 10.1016/j.jpeds.2014.07.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/14/2014] [Accepted: 07/24/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize factors associated with readmission for acute asthma exacerbation, particularly around caregiver asthma knowledge, beliefs, and reported adherence to prescribed medication regimens. STUDY DESIGN We enrolled 601 children (aged 1-16 years) who had been hospitalized for asthma. Caregivers completed a face-to-face survey regarding their asthma knowledge, beliefs, and medication adherence. Caregivers also reported demographic data, child's asthma severity, exposure to triggers, access to primary care, and financial strains. We prospectively identified asthma readmission events via billing data over a 1-year minimum follow-up period. We examined time to readmission with Cox proportional hazards. RESULTS The study cohort's median age was 5 years, 53% were African American, and 57% were covered by Medicaid. At 1 year, 22% had been readmitted for asthma. In the multivariate analysis, a caregiver's demonstration of increased asthma knowledge was associated with increased readmission risk. In addition, children whose caregivers reported less-than-perfect adherence to daily medication regimens had increased readmission risk. Likewise, having previously been admitted for asthma, decreased medical home access, and black race were associated with increased readmission risk. CONCLUSION In a multifactorial assessment of risk factors for asthma readmission, greater asthma knowledge and decreased medication adherence were associated with readmission. Inpatient efforts to prevent readmission might best target medication adherence rather than continuing to primarily provide asthma education.
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Affiliation(s)
- Katherine A Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Robert S Kahn
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Matthew M Davis
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Gerald R Ford School of Public Policy, University of Michigan, Ann Arbor, MI
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Shaw MR, Oneal G. Living on the edge of asthma: A grounded theory exploration. J SPEC PEDIATR NURS 2014; 19:296-307. [PMID: 24888671 DOI: 10.1111/jspn.12080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/12/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Most asthma-related emergency department (ED) visits and hospitalizations for asthma are preventable. Our purpose was to develop a grounded theory to guide interventions to reduce unnecessary hospitalizations and ED visits. DESIGN AND METHODS Grounded theory inquiry guided interviews of 20 participants, including 13 parents and 7 children. RESULTS Living on the edge of asthma was the emergent theory. Categories included: balancing, losing control, seeking control, and transforming. PRACTICE IMPLICATIONS The theory provides the means for nurses to understand the dynamic process that families undergo in trying to prevent and then deal with and learn from an acute asthma attack requiring hospitalization or an ED visit.
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Affiliation(s)
- Michele R Shaw
- College of Nursing, Washington State University, Spokane, Washington, USA
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