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Comparative Study
. 2012 Feb;129(2):e325-32.
doi: 10.1542/peds.2010-3302. Epub 2012 Jan 16.

Multicenter analysis of quality indicators for children treated in the emergency department for asthma

Marion R Sills  1 , Adit A Ginde, Sunday Clark, Carlos A Camargo Jr
Affiliations
Comparative Study

Multicenter analysis of quality indicators for children treated in the emergency department for asthma

Marion R Sills et al. Pediatrics. 2012 Feb.

Abstract

Objective: To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.

Methods: Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.

Results: In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely β-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely β-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association.

Conclusions: We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.

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Figures

FIGURE 1
FIGURE 1
Histogram showing pulmonary index score cut-point derivation based on proportion admitted.
See this image and copyright information in PMC

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