Quality Indicators of Pediatric Asthma Care in the Emergency Department; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 January 2024
,
Page e26
https://doi.org/10.22037/aaem.v12i1.2214
Abstract
Introduction: The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care. Methods: We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools.
Results: We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances.
Conclusions: A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.
- Quality indicators, health care
- Asthma
- Pediatric emergency medicine
- Emergency service, hospital
How to Cite
References
Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469-78.
Homaira N, Wiles LK, Gardner C, Molloy CJ, Arnolda G, Ting HP, et al. Assessing appropriateness of paediatric asthma management: A population-based sample survey. Respirology. 2020;25(1):71-9.
Choi J, Lee GL. Common pediatric respiratory emergencies. Emergency Medicine Clinics. 2012;30(2):529-63.
System CotFoECitUSH. Emergency care for children: growing pains. National Academies Press Washington, DC; 2007.
Moorman JE, Akinbami LJ, Bailey CM, Zahran HS, King ME, Johnson CA, et al. National surveillance of asthma: United States, 2001-2010. Vital & health statistics Series 3, Analytical and epidemiological studies. 2012(35):1-58.
Campbell SM, Roland MO, Buetow SA. Defining quality of care. Social science & medicine. 2000;51(11):1611-25.
Lugo SE, Pavlicich V. Quality in triage: indicators in patients with respiratory disease. Pediatr Emerg Care. 2013;29(6):710-4.
America CoQoHCi. Crossing the quality chasm: a new health system for the 21st century: National Academies Press; 2001.
Knapp JF, Simon SD, Sharma V. Variation and trends in ED use of radiographs for asthma, bronchiolitis, and croup in children. Pediatrics. 2013;132(2):245-52.
Knapp JF, Simon SD, Sharma V. Quality of care for common pediatric respiratory illnesses in United States emergency departments: analysis of 2005 National Hospital Ambulatory Medical Care Survey Data. Pediatrics. 2008;122(6):1165-70.
Johnson LH, Chambers P, Dexheimer JW. Asthma-related emergency department use: current perspectives. Open Access Emerg Med. 2016;8:47-55.
Guttmann A, Razzaq A, Lindsay P, Zagorski B, Anderson GM. Development of measures of the quality of emergency department care for children using a structured panel process. Pediatrics. 2006;118(1):114-23.
Mangione-Smith R, Roth CP, Britto MT, Chen AY, McGalliard J, Boat TF, et al. Development and Testing of the P ediatric R espiratory I llness Me asurement S ystem (PRIMES) Quality Indicators. Hospital Pediatrics. 2017;7(3):125-33.
Schull MJ, Guttmann A, Leaver CA, Vermeulen M, Hatcher CM, Rowe BH, et al. Prioritizing performance measurement for emergency department care: consensus on evidencebased quality of care indicators. Canadian Journal of Emergency Medicine. 2011;13(5):300-9.
Flores G, Lee M, Bauchner H, Kastner B. Pediatricians' attitudes, beliefs, and practices regarding clinical practice guidelines: a national survey. Pediatrics. 2000;105(3 Pt 1):496-501.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336-41.
Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743-8.
Institute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US)
Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled clinical trials. 1986;7(3):177-88.
studies TJBICAtWfa. CRITICAL APPRAISAL TOOLS: JBI; 2023 [Available from: https://jbi.global/critical-appraisal-tools.
Buckmaster A, Boon R. Reduce the rads: a quality assurance project on reducing unnecessary chest X-rays in children with asthma. J Paediatr Child Health. 2005;41(3):107-11.
Education NA, Program P, Lung, Institute) B. Expert panel report: guidelines for the diagnosis and management of asthma: update on selected topics, 2002: US Department of Health and Human Services, Public Health Service, National …; 2003.
Doherty S, Jones P, Stevens H, Davis L, Ryan N, Treeve V. 'Evidence-based implementation' of paediatric asthma guidelines in a rural emergency department. J Paediatr Child Health. 2007;43(9):611-6.
Rubin HR, Pronovost P, Diette GB. The advantages and disadvantages of process-based measures of health care quality. Int J Qual Health Care. 2001;13(6):469-74.
Stang AS, Straus SE, Crotts J, Johnson DW, Guttmann A. Quality indicators for high acuity pediatric conditions. Pediatrics. 2013;132(4):752-62.
Schumacher DJ, Holmboe ES, Van Der Vleuten C, Busari JO, Carraccio C. Developing resident-sensitive quality measures: A model from pediatric emergency medicine. Academic Medicine. 2018;93(7):1071-8.
Schumacher DJ, Martini A, Holmboe E, Varadarajan K, Busari J, van der Vleuten C, et al. Developing resident-sensitive quality measures: Engaging stakeholders to inform next steps. Academic Pediatrics. 2019;19(2):177-85.
Bardach NS, Vittinghoff E, Asteria-Peñaloza R, Edwards JD, Yazdany J, Lee HC, et al. Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics. 2013;132(3):429-36.
Sills MR, Ginde AA, Clark S, Camargo Jr CA. Multicenter analysis of quality indicators for children treated in the emergency department for asthma. Pediatrics. 2012;129(2):e325-e32.
Kocher KE, Arora R, Bassin BS, Benjamin LS, Bolton M, Dennis BJ, et al. Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC). Annals of emergency medicine. 2020;75(2):192-205.
Knapp JF, Hall M, Sharma V. Benchmarks for the emergency department care of children with asthma, bronchiolitis, and croup. Pediatric emergency care. 2010;26(5):364-9.
Sills MR, Fairclough D, Ranade D, Kahn MG. Emergency department crowding is associated with decreased quality of care for children with acute asthma. Annals of emergency medicine. 2011;57(3):191-200. e7.
Montealegre F, Chardon D, Vargas W, Bayona M, Zavala D. Measuring asthma disparities in Hispanics: adherence to the national guidelines for asthma treatment in emergency departments in Puerto Rico. Annals of Allergy, Asthma & Immunology. 2004;93(5):472-7.
Schumacher DJ, Martini A, Holmboe E, Carraccio C, van der Vleuten C, Sobolewski B, et al. Initial Implementation of Resident-Sensitive Quality Measures in the Pediatric Emergency Department: A Wide Range of Performance. Acad Med. 2020;95(8):1248-55.
Dexheimer JW, Abramo TJ, Arnold DH, Johnson KB, Shyr Y, Ye F, et al. An asthma management system in a pediatric emergency department. Int J Med Inform. 2013;82(4):230-8.
Browne GJ, Giles H, Mccaskill ME, Fasher BJ, Lam LT. The benefits of using clinical pathways for managing acute paediatric illness in an emergency department. Journal of quality in clinical practice. 2001;21(3):50-5.
de Mingo Alemany MC, Campos Andreu A, Ferrer Lorente B, López Salgueiro R. Medical audit on children with asthma in an Emergency Department. Allergol Immunopathol (Madr). 2009;37(4):198-202.
- Abstract Viewed: 536 times
- pdf Downloaded: 1030 times