Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Discussion
In relation to the national guidelines, the Chicago-area hospitals responding to this survey appear to perform well, especially in providing bedside services such as nebuliza-tion therapy, patient instruction on peak flow monitoring, and evaluation of inhaler technique. However, just over half of the hospitals routinely provide asthma education to patients prior to discharge. In the future, it would be important to better understand how asthma education in the inpatient setting affects patient outcomes.
Many of the hospitals indicated they have adopted some form of asthma care practice guidelines or critical pathways. The survey results also suggest that the hospitals with guidelines were more likely to have well-developed asthma education programs. As more and more hospitals continue to adopt guidelines and critical paths, it is important to further understand their usefulness. The similarities between the academic and nonacademic institutions in the use of guidelines, critical pathways, or other asthma services may reflect a lack of leadership on the part of the academic institutions to serve as role models for the nonacademic institutions. website
While there appear to be no studies of the effects of hospital-based asthma guidelines on patient outcomes, at least two studies have examined the impact of asthma-specific critical pathways. These studies produced mixed results. McDowell et al studied the effects of an asthma critical pathway on the hospitalization experience of children with status asthmaticus. Using a quasi-experimental design, the authors reported significantly shorter lengths of stay for children treated via the pathway, with no apparent impact on short-term (72-h) readmission rates, and some important savings in total costs of inpatient care. Alternatively, Kwan-Gett et al, using a pre-evaluation and postevaluation analysis to study the effect of asthma critical pathways, found no significant differences in length of stay and similar total charges (with only slightly lower laboratory and radiology charges).