Multicenter Analysis of Quality Indicators for Children Treated in the Emergency Department for Asthma

作者：Sills Marion R; Ginde Adit A; Clark Sunday; Camargo Carlos A^*

来源：Pediatrics, 2012, 129(2): E325-E332.

DOI：10.1542/peds.2010-3302

• asthma
• outcome and process assessments (health care)
• quality of health care
• Severity of Illness Index
• practice guideline
• antiasthmatic agents
• asthma
• preschool child
• child
• adolescent

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 beta-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely beta-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 children in a multicenter study study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes. Pediatrics 2012;129:e325-e332

• 出版日期2012-2