Improved outcomes for hospitalized asthmatic children using a clinical pathway

Background: Although asthma clinical pathways are used with increasing freq uency, few controlled studies have evaluated the clinical and cost effectiv eness of these pathways. Objective: To evaluate the effect of an inpatient asthma clinical pathway o n cost and quality of care for children with asthma. Methods: One hundred forty-nine children were treated for status asthmaticu s using an asthma clinical pathway in a children's hospital between Septemb er and December 1997. Thirty-four of 149 children treated with the clinical pathway were randomly selected. A retrospective cohort control group of no n-pathway patients (N = 34) was matched with each pathway patient by age, r ace, gender, comorbidities, asthma severity score, ICU admission, and time of year admitted. Differences between the two groups in length of stay, tot al costs, readmission rate, inpatient management, and discharge medications were compared. Results: Length of stay was significantly lower in the clinical pathway gro up compared with the control group (36 hours versus 71 hours, P <.001) and total costs decreased significantly ($1685 versus $2829, P <.001) as a resu lt of the pathway. Asthmatic children on the clinical pathway were signific antly more likely than the control group to complete asthma teaching while hospitalized (65% versus 18%, P <.001), to be discharged with a prescriptio n for a controller medication (88% versus 53%, P <.01), and to have a peak flow meter (57% versus 23%, P <.05) and a spacer device (100% versus 71%, P <.001) for home use. Conclusion: Implementation of this inpatient clinical pathway led to a decr ease in length of stay and a reduction in total cost while improving qualit y of care for hospitalized asthmatic children.