The PIPA Study (Pathways for Improving Pediatric Asthma Care): A Cluster Randomized Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 303
- 试验地点
- 2
- 主要终点
- Hospital/Inpatient: Mean length of hospital stay
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Working as a physician at the study site
排除标准
- •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
结局指标
主要结局
Hospital/Inpatient: Mean length of hospital stay
时间窗: 1 year
Emergency Department: Proportion of eligible children who receive systemic steroids within 60 minutes of ED arrival
时间窗: 1 year
次要结局
- 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)