IMPACT OF CLINICAL PATHWAYS AND PRACTICE GUIDELINES ON THE MANAGEMENTOF ACUTE EXACERBATIONS OF BRONCHIAL-ASTHMA

Objectives: In 1990, it was estimated that approximately 1% of all US health-care costs (approximately $6.2 billion) were spent on asthma-re lated health expenses. Of this, hospitalization charges alone exceeded $2.6 billion. Practice guidelines and clinical pathways are being dev eloped to standardize the management of acute asthma with the aim of i mproving care and safely reducing health-care costs. In this report, w e evaluate the impact of an asthma pathway developed and instituted at a large community-based teaching hospital. This pathway was evidence based and was developed by a multidisciplinary) group. Methods: The st udy was conducted during a 6-month period in 1995, while a similar per iod in 1994 was used as a historical control period. Data collected in cluded patient demographics, hospital admission and discharge peak exp iratory flow rates, pulse oximetry measurements, length of stay, conve rsion from hand-held nebulizer to metered-close inhaler, use of cortic osteroids within 24 h of hospitalization, and conversion of IV steroid s to oral steroids. Results: A total of 42 patients were enrolled duri ng the study period. Of these, 19 mere placed on the pathway, while 23 were not treated according to the pathway. There were 38 patients in the 1994 historical control period. For 1995, there was no significant difference between the pathway and nonpathway groups with regard to t he length of stay (4.4+/-3.3 vs 3.2+/-2.3 days; p>0.05), hospital disc harge peak expiratory now rates (324 vs 286 L/min; p>0.05), or use of steroids (100% vs 91%; p>0.05). However, a significant increase in con version from hand-held nebulizer to metered-dose inhaler was noted in the pathway group (68% vs 34%; p<0.05). The data from 1994 compared to 1995 pathway were similar in that there was no difference in the leng th of stay (3.4+/-2.1 vs 4.4+/-3.3 days; p>0.05) and/or use of steroid s (92% vs 100%; p>0.05), while a significant increase in hand-held neb ulizer to metered-dose inhaler conversion was observed for the 1995 pa thway group (68% vs 26%; p=0.002). Conclusions: We conclude that altho ugh the asthma pathway did not significantly reduce length of stay, it was associated with a significant increase in hand-held nebulizer tb metered-dose inhaler conversion, resulting in a substantial cost savin gs of $288,000/year.