The PIPA Study (Pathways for Improving Pediatric Asthma Care): A Cluster Randomized Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Asthma
- Sponsor
- University of California, San Francisco
- Enrollment
- 303
- Locations
- 1
- Primary Endpoint
- Hospital/Inpatient: Mean length of hospital stay
- Status
- Completed
- Last Updated
- 4 years ago
Overview
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:
- Emergency Department: The proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival
- 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.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Working as a physician at the study site
Exclusion Criteria
- •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
Outcomes
Primary Outcomes
Hospital/Inpatient: Mean length of hospital stay
Time Frame: 1 year
Emergency Department: Proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival
Time Frame: 1 year
Secondary Outcomes
- 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)