Evaluation of the Emergency Department Asthma Care Project
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 300
- 试验地点
- 15
- 主要终点
- % of ED visitors admitted to hospital for asthma
研究概览
简要总结
The purpose of the study is to evaluate whether the Emergency Department (ED) Asthma Care Project (ACP) leads to improved asthma care delivery and patient outcomes in the ED setting.
Hypothesis: Implementation of a multi-disciplinary asthma strategy/clinical pathway for the treatment of asthma in the ED, based upon the 1999 Canadian Asthma Consensus Guidelines (and subsequent updates), will increase adherence with published management guidelines in the ED setting, reduce variations in the emergency management of acute asthma, increase utilization of specialized asthma services and improve outcomes for patients following ED visits.
Methods:
This observational, pre- post-intervention study will compare a stratified sample of 10 Ontario hospital EDs (5 intervention and 5 control sites). Chart abstractions will be performed on all adult visits for acute asthma over a 3 month period before and after implementation of the Ontario Hospital Associations (OHA)'s (now Ontario Lung Association's (OLA's) ED Asthma Care Map. Patient and provider surveys and provider focus group post intervention will also be conducted. Primary outcome measures are hospitalizations and repeat ED visit rates. Secondary outcome measures include: length of stay in ED, self-reported adherence with referral to specialized asthma services made during index ED visit, self-reported asthma control, and use of self-management strategies (including use of action plan), use of asthma management strategies promoted by the care map (such as use of objective measure of airflow rates, use of steroids, education, referral to specialized asthma services on discharge). Ease of implementation and barriers to implementation will also be evaluated.
详细描述
Study findings may be used to support implementation of a standardized ED clinical pathway and related ED provider education program throughout Ontario.
Specific Objectives:
- To evaluate the impact of the pathway on patients.
- To evaluate the impact of the pathway on health care providers.
- To evaluate the ease of implementation of the pathway.
Study Design:
- Observational, pre- post-intervention study design.
- Comparison between intervention and control sites.
- Patient and provider surveys and provider focus group post intervention
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 盲法
- None
入排标准
- 年龄范围
- 19 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •asthma plus or minus chronic obstructive pulmonary disease (COPD)
- •ED visit for acute asthma treatment
- •age 19 years or greater
排除标准
- •COPD without asthma
- •ED visit for asthma prescription renewal only
结局指标
主要结局
% of ED visitors admitted to hospital for asthma
时间窗: At the end of the index ED visit (this is a dichotomous outcome. It is not possible to specify a "time frame").
The patient is either admitted or not at the end of the ED visit.
Repeat Emergency Department visit rate for asthma
时间窗: Within 24, 72h, 1 month
次要结局
- Hospitalization length of stay(From ED presentation to hospital discharge)
- Self-reported asthma control, and use of self-management strategies (including use of action plan)(At followup questionnaire)
- Use of Asthma Management Strategies Promoted by the ED ACP: use of objective measure of airflow rates (PEFR or spirometry), and gas exchange (oxygen saturation, arterial blood gases)(During index ED visit (between ED presentation and ED discharge).)
- ; types of asthma medications prescribed (bronchodilators, corticosteroids) in ED and upon discharge; route of medications prescribed (IV vs oral vs. inhaled steroids; MDI vs nebulized bronchodilators)(During index ED visit (between presentation and discharge, including discharge orders and instructions).)
- ; documentation of assessment and teaching of device technique(During index ED visit (between ED presentation and ED discharge))
- Length of stay in ED(From ED presentation to ED discharge)
- Self-reported adherence with referral to specialized asthma services made during index ED visit(At folllowup questionnaire)
- ; follow-up care recommendations or referrals (AEC, Asthma Clinic, Respirology Clinic, family physician)(During index ED visit (between ED presentation and ED discharge))
- ; documentation of asthma action plan provision or revision(During index ED visit (between ED presentation and ED discharge))
- ; referral rates (#/year) to local AECs and Asthma Clinics(After discharge (within 12 months))
- ; types of providers involved in emergency asthma care(During index visit (between ED presentation and ED discharge))
- Perceived utility of pathway (overall, by site, and by profession)(At time of followup survey (wihtin 12 months))
- ; type of asthma education provided (e.g. environmental trigger avoidance, warning signs, medication use)(During index ED visit (between ED presentation and ED discharge))
- Utilization of Specialized Asthma Services(After discharge (within 12 months))
- Proportion of patients enrolled on the ED ACP (Overall, by patient age category and by physician specialty)(During index visit (between ED presentation and ED discharge))
- Differences in patient demographics, physician demographics, day of week, time of day between patients enrolled vs. not enrolled(During index visit (between ED presentation and ED discharge))
研究者
Dr. Diane Lougheed
Principal Investigator
Queen's University