WIP 09 - Improving the Delivery of Equitable Evidence-Based Inpatient Asthma Care

Publication Number: WIP 09.7648

Eleanor E. Young, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer D. Treasure, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Andrew F. Beck, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Laura Brower, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States

Background: Healthcare inequities are well documented in child asthma. Quality inpatient asthma care manages the acute presentation while supporting optimal transition to home. At our institution, children identifying as members of minoritized groups are hospitalized at rates 3 times that of their White counterparts and 90-day readmission rates for asthma are rising. Recent changes to care delivery post-COVID-19 and release of updated evidence-based asthma guidelines are motivating a renewed focus on equitably improving inpatient asthma care.

Objective: To increase the proportion of patients admitted with an acute asthma exacerbation to our hospital medicine service who receive all components of optimal inpatient asthma care, defined as 1) medical and social-environmental risk assessment, 2) documentation of maintenance medication plan and, 3) accurate asthma action plan at discharge from 15% to 80% by 02/2025. We additionally seek to narrow the racial equity gaps that characterize this measure.

Design/Methods: Using quality improvement methods at a large, freestanding children’s hospital, this IRB-approved study seeks to improve delivery of equitable, quality asthma care. We defined optimal inpatient asthma care using the chronic care model, published literature, and input from local experts. We are operationalizing our measure such that a success or failure of each component is abstracted from the electronic health record. Baseline data included manual review of a random sample of one third of all asthma admissions (217 encounters) between 08/2023-08/2024. Our multidisciplinary team of clinicians and family partners formulated key drivers to inform various multimodal interventions for ongoing testing anticipated through 03/2025. Our process measure is monitored on a statistical process control chart as an all-or-none bundled measure with separate charts for each individual component. Outcome measures, segmented by race and insurance payor, will include acute care reutilization rates and connections to local resources (e.g., community health worker, health department sanitarians).