29 Sep

Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Statistical Analysis

Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Statistical AnalysisSubanalyses were conducted to determine the relationships between hospitals that were (1) urban vs suburban, (2) academic vs nonacademic, and (3) those reported to use asthma practice guidelines vs those that were not.
Hospitals were classified as urban if they were located within the city of Chicago (based on postal zones), and suburban if they were located outside the city postal zones. Academic status was based on criteria from the 1995 American Hospital Association Guidebook. Hospitals were considered academic if they were approved to participate in residency training by the Accreditation Council for Graduate Medical Education, reported medical school affiliation to the American Medical Association, and were a member of Council of Teaching Hospitals of the Association of American Medical Colleges.
This project was conducted under the approval of the Rush-Presbyterian-St. Luke’s Medical Center Institutional Review Board. Link

Results
General Characteristics of Hospitals
Completed surveys were received from 59 of the 89 eligible hospitals, for a response rate of 66.3%. Using the Illinois Health Care Cost Containment Council data set, the responding hospitals were compared with the nonrespondents for total number of annual discharges, total bed days, and average length of stay. The comparison revealed that the hospitals responding to the survey had more annual total discharges and total bed days (p < 0.05) than the nonrespondents; both groups had similar lengths of stay.
Characteristics of Inpatient Settings
As seen in Table 1, of the 59 hospitals completing the survey, 42.4% reported using practice guidelines for inpatient asthma management, and 37.3% reported using asthma critical pathways. An additional 18.6% of the hospitals reported that they were developing asthma guidelines, and 15.3% were developing critical pathways.

Table 1—Characteristics of Asthma-Related Inpatient Care Activities in Chicago-Area Hospitals

Characteristics All Hospitals (n = 59) AsthmaGuidelines p Value Location p Value Academic Medical Center p Value
Yes (n = 25) No (n = 34) Urban (n = 26) Suburban(n = 33) Yes (n = 13) No (n = 46)
Hospital wide
Currently using guidelines, % 42.4 38.5 45.5 0.59 38.5 43.5 0.75
Currently using critical pathways, % 37.3 80.0 5.9 0.001 42.3 33.3 0.48 46.2 34.8 0.45
ICU-specific
Currently using guidelines, % 25.9 48.0 8.8 0.001 34.6 18.2 0.15 15.4 28.3 0.35
Currently using critical pathways, % 18.6 36.0 5.9 0.003 30.8 9.1 0.03 15.4 19.6 0.73
Care at bedside
Nebulization, % 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Peak flow monitoring, % 96.6 100.0 94.1 0.22 96.2 97.0 0.86 100.0 95.7 0.44
Peak flow instruction, % 86.4 100.0 76.5 0.01 80.8 90.9 0.26 76.9 89.1 0.26
Evaluation of inhaler technique, % 93.2 100.0 88.2 0.08 88.5 97.0 0.20 84.6 95.7 0.16
Care at bedside
Inhaled anti-inflammatories, % 72.4 80.0 66.7 0.26 68.0 75.8 0.51 84.6 68.9 0.26
Asthma education, % 52.5 84.0 29.4 0.001 50.0 54.6 0.73 46.2 54.4 0.60

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