Improving Quality of Acute Asthma Care in US Hospitals

Changes Between 1999-2000 and 2012-2013

Kohei Hasegawa, Yusuke Tsugawa, Sunday Clark, Carly D. Eastin, Susan Gabriel, Vivian Herrera, Jane C. Bittner, Carlos A. Camargo, Jason Ahn, Taruna Aurora, Barry Brenner, Mark A. Brown, William Calhoun, John E. Gough, Asal Gharib, Jonathan Heidt, Mehdi Khosravi, Wendy C. Moore, Nee Kofi Mould-Millman, Stephanie Nonas & 11 others Richard Nowak, Veronica Pei, Valerie G. Press, Beatrice D. Probst, Sima K. Ramratnam, Matthew Tallar, Suzanne S. Teuber, Stacy A. Trent, Roberto Villarreal, Taketo Watase, Scott Youngquist

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Little is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS). Methods This study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS. Results The analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P <.001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (–14% [95% CI, –23 to –4]; P =.009). Conclusions Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.

Original languageEnglish (US)
Pages (from-to)112-122
Number of pages11
JournalChest
Volume150
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Asthma
Guidelines
Length of Stay
Inpatients
Hospitalized Child
Patient Care

Keywords

  • asthma
  • guideline
  • hospitalization
  • quality of care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hasegawa, K., Tsugawa, Y., Clark, S., Eastin, C. D., Gabriel, S., Herrera, V., ... Youngquist, S. (2016). Improving Quality of Acute Asthma Care in US Hospitals: Changes Between 1999-2000 and 2012-2013. Chest, 150(1), 112-122. https://doi.org/10.1016/j.chest.2016.03.037

Improving Quality of Acute Asthma Care in US Hospitals : Changes Between 1999-2000 and 2012-2013. / Hasegawa, Kohei; Tsugawa, Yusuke; Clark, Sunday; Eastin, Carly D.; Gabriel, Susan; Herrera, Vivian; Bittner, Jane C.; Camargo, Carlos A.; Ahn, Jason; Aurora, Taruna; Brenner, Barry; Brown, Mark A.; Calhoun, William; Gough, John E.; Gharib, Asal; Heidt, Jonathan; Khosravi, Mehdi; Moore, Wendy C.; Mould-Millman, Nee Kofi; Nonas, Stephanie; Nowak, Richard; Pei, Veronica; Press, Valerie G.; Probst, Beatrice D.; Ramratnam, Sima K.; Tallar, Matthew; Teuber, Suzanne S.; Trent, Stacy A.; Villarreal, Roberto; Watase, Taketo; Youngquist, Scott.

In: Chest, Vol. 150, No. 1, 01.07.2016, p. 112-122.

Research output: Contribution to journalArticle

Hasegawa, K, Tsugawa, Y, Clark, S, Eastin, CD, Gabriel, S, Herrera, V, Bittner, JC, Camargo, CA, Ahn, J, Aurora, T, Brenner, B, Brown, MA, Calhoun, W, Gough, JE, Gharib, A, Heidt, J, Khosravi, M, Moore, WC, Mould-Millman, NK, Nonas, S, Nowak, R, Pei, V, Press, VG, Probst, BD, Ramratnam, SK, Tallar, M, Teuber, SS, Trent, SA, Villarreal, R, Watase, T & Youngquist, S 2016, 'Improving Quality of Acute Asthma Care in US Hospitals: Changes Between 1999-2000 and 2012-2013', Chest, vol. 150, no. 1, pp. 112-122. https://doi.org/10.1016/j.chest.2016.03.037
Hasegawa K, Tsugawa Y, Clark S, Eastin CD, Gabriel S, Herrera V et al. Improving Quality of Acute Asthma Care in US Hospitals: Changes Between 1999-2000 and 2012-2013. Chest. 2016 Jul 1;150(1):112-122. https://doi.org/10.1016/j.chest.2016.03.037
Hasegawa, Kohei ; Tsugawa, Yusuke ; Clark, Sunday ; Eastin, Carly D. ; Gabriel, Susan ; Herrera, Vivian ; Bittner, Jane C. ; Camargo, Carlos A. ; Ahn, Jason ; Aurora, Taruna ; Brenner, Barry ; Brown, Mark A. ; Calhoun, William ; Gough, John E. ; Gharib, Asal ; Heidt, Jonathan ; Khosravi, Mehdi ; Moore, Wendy C. ; Mould-Millman, Nee Kofi ; Nonas, Stephanie ; Nowak, Richard ; Pei, Veronica ; Press, Valerie G. ; Probst, Beatrice D. ; Ramratnam, Sima K. ; Tallar, Matthew ; Teuber, Suzanne S. ; Trent, Stacy A. ; Villarreal, Roberto ; Watase, Taketo ; Youngquist, Scott. / Improving Quality of Acute Asthma Care in US Hospitals : Changes Between 1999-2000 and 2012-2013. In: Chest. 2016 ; Vol. 150, No. 1. pp. 112-122.
@article{2a7cb9aba75e437383d81bc53366bfbe,
title = "Improving Quality of Acute Asthma Care in US Hospitals: Changes Between 1999-2000 and 2012-2013",
abstract = "Background Little is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS). Methods This study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS. Results The analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P <.001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (–14{\%} [95{\%} CI, –23 to –4]; P =.009). Conclusions Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.",
keywords = "asthma, guideline, hospitalization, quality of care",
author = "Kohei Hasegawa and Yusuke Tsugawa and Sunday Clark and Eastin, {Carly D.} and Susan Gabriel and Vivian Herrera and Bittner, {Jane C.} and Camargo, {Carlos A.} and Jason Ahn and Taruna Aurora and Barry Brenner and Brown, {Mark A.} and William Calhoun and Gough, {John E.} and Asal Gharib and Jonathan Heidt and Mehdi Khosravi and Moore, {Wendy C.} and Mould-Millman, {Nee Kofi} and Stephanie Nonas and Richard Nowak and Veronica Pei and Press, {Valerie G.} and Probst, {Beatrice D.} and Ramratnam, {Sima K.} and Matthew Tallar and Teuber, {Suzanne S.} and Trent, {Stacy A.} and Roberto Villarreal and Taketo Watase and Scott Youngquist",
year = "2016",
month = "7",
day = "1",
doi = "10.1016/j.chest.2016.03.037",
language = "English (US)",
volume = "150",
pages = "112--122",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1",

}

TY - JOUR

T1 - Improving Quality of Acute Asthma Care in US Hospitals

T2 - Changes Between 1999-2000 and 2012-2013

AU - Hasegawa, Kohei

AU - Tsugawa, Yusuke

AU - Clark, Sunday

AU - Eastin, Carly D.

AU - Gabriel, Susan

AU - Herrera, Vivian

AU - Bittner, Jane C.

AU - Camargo, Carlos A.

AU - Ahn, Jason

AU - Aurora, Taruna

AU - Brenner, Barry

AU - Brown, Mark A.

AU - Calhoun, William

AU - Gough, John E.

AU - Gharib, Asal

AU - Heidt, Jonathan

AU - Khosravi, Mehdi

AU - Moore, Wendy C.

AU - Mould-Millman, Nee Kofi

AU - Nonas, Stephanie

AU - Nowak, Richard

AU - Pei, Veronica

AU - Press, Valerie G.

AU - Probst, Beatrice D.

AU - Ramratnam, Sima K.

AU - Tallar, Matthew

AU - Teuber, Suzanne S.

AU - Trent, Stacy A.

AU - Villarreal, Roberto

AU - Watase, Taketo

AU - Youngquist, Scott

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background Little is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS). Methods This study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS. Results The analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P <.001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (–14% [95% CI, –23 to –4]; P =.009). Conclusions Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.

AB - Background Little is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS). Methods This study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS. Results The analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P <.001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (–14% [95% CI, –23 to –4]; P =.009). Conclusions Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.

KW - asthma

KW - guideline

KW - hospitalization

KW - quality of care

UR - http://www.scopus.com/inward/record.url?scp=84990032226&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990032226&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2016.03.037

DO - 10.1016/j.chest.2016.03.037

M3 - Article

VL - 150

SP - 112

EP - 122

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1

ER -