Inpatient quality improvement interventions for asthma: A meta-analysis

Kavita Parikh, Susan Keller, Shawn Ralston

Research output: Contribution to journalArticle

Abstract

CONTEXT: Despite the availability of evidence-based guidelines for the management of pediatric asthma, health care utilization remains high. OBJECTIVE: Systematically review the inpatient literature on asthma quality improvement (QI) and synthesize impact on subsequent health care utilization. DATA SOURCES: Medline and Cumulative Index to Nursing and Allied Health Literature (January 1, 1991-November 16, 2016) and bibliographies of retrieved articles. STUDY SELECTION: Interventional studies in English of inpatient-initiated asthma QI work. DATA EXTRACTION: Studies were categorized by intervention type and outcome. Random-effects models were used to generate pooled risk ratios for health care utilization outcomes after inpatient QI interventions. RESULTS: Thirty articles met inclusion criteria and 12 provided data on health care reutilization outcomes. Risk ratios for emergency department revisits were: 0.97 (95% confidence interval [CI]: 0.06-14.47) <30 days, 1.70 (95% CI: 0.67-4.29) for 30 days to 6 months, and 1.22 (95% CI: 0.52-2.85) for 6 months to 1 year. Risk ratios for readmissions were: 2.02 (95% CI: 0.73-5.61) for <30 days, 1.68 (95% CI: 0.88-3.19) for 30 days to 6 months, and 1.27 (95% CI 0.85-1.90) for 6 months to 1 year. Subanalysis of multimodal interventions suggested lower readmission rates (risk ratio: 1.49 [95% CI: 1.17-1.89] over a period of 30 days to 1 year after the index admission). Subanalysis of education and discharge planning interventions did not show effect. LIMITATIONS: Linkages between intervention and outcome are complicated by the multimodal approach to QI in most studies. CONCLUSIONS: We did not identify any inpatient strategies impacting health care reutilization within 30 days of index hospitalization. Multimodal interventions demonstrated impact over the longer interval.

Original languageEnglish (US)
Article numbere20173334
JournalPediatrics
Volume141
Issue number5
DOIs
StatePublished - May 1 2018
Externally publishedYes

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Quality Improvement
Meta-Analysis
Inpatients
Asthma
Confidence Intervals
Patient Acceptance of Health Care
Odds Ratio
Delivery of Health Care
Patient Discharge
Bibliography
Hospital Emergency Service
Hospitalization
Nursing
Guidelines
Pediatrics
Education
Health

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Inpatient quality improvement interventions for asthma : A meta-analysis. / Parikh, Kavita; Keller, Susan; Ralston, Shawn.

In: Pediatrics, Vol. 141, No. 5, e20173334, 01.05.2018.

Research output: Contribution to journalArticle

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abstract = "CONTEXT: Despite the availability of evidence-based guidelines for the management of pediatric asthma, health care utilization remains high. OBJECTIVE: Systematically review the inpatient literature on asthma quality improvement (QI) and synthesize impact on subsequent health care utilization. DATA SOURCES: Medline and Cumulative Index to Nursing and Allied Health Literature (January 1, 1991-November 16, 2016) and bibliographies of retrieved articles. STUDY SELECTION: Interventional studies in English of inpatient-initiated asthma QI work. DATA EXTRACTION: Studies were categorized by intervention type and outcome. Random-effects models were used to generate pooled risk ratios for health care utilization outcomes after inpatient QI interventions. RESULTS: Thirty articles met inclusion criteria and 12 provided data on health care reutilization outcomes. Risk ratios for emergency department revisits were: 0.97 (95{\%} confidence interval [CI]: 0.06-14.47) <30 days, 1.70 (95{\%} CI: 0.67-4.29) for 30 days to 6 months, and 1.22 (95{\%} CI: 0.52-2.85) for 6 months to 1 year. Risk ratios for readmissions were: 2.02 (95{\%} CI: 0.73-5.61) for <30 days, 1.68 (95{\%} CI: 0.88-3.19) for 30 days to 6 months, and 1.27 (95{\%} CI 0.85-1.90) for 6 months to 1 year. Subanalysis of multimodal interventions suggested lower readmission rates (risk ratio: 1.49 [95{\%} CI: 1.17-1.89] over a period of 30 days to 1 year after the index admission). Subanalysis of education and discharge planning interventions did not show effect. LIMITATIONS: Linkages between intervention and outcome are complicated by the multimodal approach to QI in most studies. CONCLUSIONS: We did not identify any inpatient strategies impacting health care reutilization within 30 days of index hospitalization. Multimodal interventions demonstrated impact over the longer interval.",
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