Implementing Pathways to Improve Pediatric Asthma Care

Not Applicable

Completed

• Conditions: Asthma
• Interventions: Behavioral: PIPA Intervention Bundle 1; Behavioral: PIPA Intervention Bundle 2

• Registration Number: NCT03736603
• Lead Sponsor: University of California, San Francisco

Brief Summary

Background:

Asthma affects nearly 10% of American children, and is a leading cause of pediatric emergency visits and hospitalizations. Clinical pathways are operational versions of practice guidelines aimed at the hospital management of common illnesses. Single-site studies of pediatric asthma pathways have shown significant improvements in quality of care.

Primary Objective:

To evaluate the effectiveness of clinical pathways for improving quality of care for children with asthma in a diverse, national sample of emergency department (ED) and hospital settings.

Primary Endpoints:

1. Emergency Department: The proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival

2. Inpatient/Hospital: Mean length of hospital stay

Study Design:

This project will be implemented through an established quality improvement collaborative of hospitals across the United States, the Value in Inpatient Pediatrics Network (part of the American Academy of Pediatrics). A cluster randomized design will be employed. Group 1 hospitals will receive a multifaceted implementation strategy that includes: 1) a pathway implementation toolkit, 2) local multidisciplinary champions in the ED and inpatient settings, 3) audit and feedback, 4) educational seminars, and 5) practice facilitation (via teleconference). Group 2 will receive the same intervention with the addition of a mobile app pathway tool.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-01-01
• Study First Submitted: 2018-11-07
• Study First Submitted QC: 2018-11-07
• Study First Posted: 2018-11-09
• Primary Completion: 2019-06-30
• Study Completion: 2019-06-30
• Status Verified: 2022-03
• Last Update Submitted: 2022-03-07
• Last Update Posted: 2022-03-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 303

Inclusion Criteria

• Working as a physician at the study site

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Exclusion Criteria

• None

Patient/child eligibility criteria:

Inclusion Criteria:

• Age 2-17 years
• Primary diagnosis of asthma

Exclusion Criteria:

• Transferred in from another inpatient facility
• Presence of a chronic medical condition that precludes pathway use

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Pathway Intervention 1	PIPA Intervention Bundle 1	Hospitals randomized to group 1 receive PIPA Intervention Bundle 1.
Pathway Intervention 2	PIPA Intervention Bundle 2	Hospitals randomized to group 2 receive PIPA Intervention Bundle 2, which adds a mobile app.

Primary Outcome Measures

Name	Time	Method
Hospital/Inpatient: Mean length of hospital stay	1 year
Emergency Department: Proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival	1 year

Secondary Outcome Measures

Name	Time	Method
Hospital/Inpatient: Proportion of children screened for secondhand tobacco smoke exposure	1 year
Hospital/Inpatient: Proportion of children prescribed antibiotics at hospital discharge	1 year
Hospital/Inpatient: Proportion of children with administration of bronchodilator via metered-dose inhaler early in hospitalization	1 year
Hospital/Inpatient: Proportion of children with emergency department visits or readmissions to the hospital within 7 days	1 year
Emergency Department: Proportion of children who get an asthma exacerbation severity assessment at ED triage	1 year
Emergency Department: Proportion of children who have chest radiographs performed	1 year
Hospital/Inpatient: Proportion of children who screen positive for secondhand tobacco smoke exposure whose caregivers are referred to smoking cessation resources	1 year
Hospital/Inpatient: Proportion of children transferred to a higher level of care	1 year
Emergency Department: Proportion of children transferred to a higher level of care	1 year
Emergency Department: Proportion of children admitted to the hospital	1 year
Emergency Department: Mean length of emergency department stay	1 year

Trial Locations

Locations (1)

University of California; 🇺🇸 San Francisco, California, United States