Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Conclusion
Although there are important limitations, this survey still provides new insights into the asthma care delivered by a large group of hospitals located in one geographical area. Several audits of hospital-based asthma care conducted outside of the United States have been published; however, these studies almost exclusively examine individual hospital performance rather than taking a community-based approach to performance measurement. These non-United States audits revealed that while much of the inpatient medical treatment appeared to be adequate, the hospitals demonstrated consistently low performance in the areas of formal patient education programs and objective lung assessment by peak flow. website
In a multisite study of inpatient pediatric asthma care conducted in Brighton, England, chart audits revealed important variations in asthma care practices. In particular, the study revealed variations in documentation of pulse oximetry, the use of chest radiographs, the use of treatment protocols, documentation of proper inhaler technique prior to discharge, and documentation of written treatment plans given at discharge.
As with the study in England, the findings of the Chicago-area hospital survey bring to light specific areas where there are opportunities to improve hospital-based care for persons with asthma. This Chicago-area study also emphasizes the potential for using practice guidelines as a marker for enhanced asthma-related activities and programs. While a cross-sectional survey design such as this cannot evaluate a causal relationship between the presence of guidelines and quality of asthma programs, it does suggest the need to better understand this relationship. A more detailed, chart-audit-based, community-wide examination of asthma care delivered by hospitals with and without guidelines could be an important next step in motivating change, reducing variation, and improving the quality of asthma care.