Quality Improvement Approach Reduces Pediatric Asthma Emergency Department Visits by 33%

With institutional support, a primary care-based quality improvement initiative markedly reduced asthma-related emergency department visits for children with asthma.

Researchers at Nationwide Children’s Hospital implemented a quality improvement (QI) project that reduced pediatric asthma emergency department (ED) visits by 33% from 2010 to 2019. Stephen Hersey, MD, a pediatrician in Nationwide Children’s section of primary care pediatrics, led the research effort.

Asthma exacerbation, characterized by symptoms such as wheezing and persistent cough, contributes to hundreds of thousands of asthma ED visits for the millions of children with asthma in the United States.

Children who are Medicaid-eligible, comprising most patients in Nationwide Children’s primary care network, are more likely to experience poor asthma control and have more asthma ED visits.

Interventions including asthma action plans and the Asthma Control Test (ACT) reduce asthma ED visits.

“Before our intervention of using a standard evidence-based asthma note, the primary care network did not have a standardized approach to assessing and managing asthma. Using the asthma note allows us to do both efficiently,” says Dr. Hersey.

Dr. Hersey and his team conducted a multi-year QI project to reduce asthma ED visits by 3% annually for asthma patients aged 2 to 18 years. Results were published in Pediatrics.

The researchers analyzed data on pediatric asthma ED visits from January 2010 to December 2019, excluding the COVID-19 pandemic because asthma ED visits sharply decreased during the pandemic.

Data from approximately 8,600 asthma patients were collected, with 88% either enrolled in Medicaid or uninsured. Roughly 58% of the patients were male, and 66% were Black.

From 2011 to 2015, they sequentially implemented five core QI interventions to allow providers sufficient time to learn about the interventions, and then adapt to and accept them.