title: Impact of a pediatric asthma clinical pathway on hospital cost and length of stay.
abstract: This study sought to determine if a clinical pathway developed and executed by specialists in pediatric asthma would reduce hospital costs and length of stay (LOS). The study design was a retrospective, nonrandomized, controlled trial. Subjects were children aged 2-18 years (N = 1,004) with a history of recurrent wheezing, hospitalized with a diagnosis of acute asthma exacerbation between 1995-1998 at the New York Hospital-Weill Cornell Medical Center and treated via the pathway, as well as a control group of 206 children ages 2-18 hospitalized for acute asthma exacerbation in 1994, the year prior to pathway implementation. Patients were treated via the pathway under the supervision of an asthma specialist. The pathway provided guidelines for: 1) frequency of patient assessment; 2) bronchodilator usage; 3) corticosteroid use; 4) laboratory evaluation; 5) vital signs, oxygen saturation, and peak flow measurements; 6) chest x-rays; 7) social work intervention; and 8) discharge planning. The main outcome measures were hospital length of stay, cost per hospitalization, nursing, medication, laboratory and radiology costs, and relapse rate. Total charges for admission and average LOS for 1995-1998 were calculated, and compared with 1994, the year preceding implementation of the pathway. LOS decreased from 4.2 days to 2.7 days (P < 0.0001). The annual total charges for pediatric asthma admissions decreased from 2 million dollars to 1.4 million dollars (P < 0.005). Nursing and laboratory costs showed a statistically significant decrease. Follow-up study at 8 months showed a readmission rate of 0.02%. The implementation of a pediatric asthma clinical pathway, directed by specialists, resulted in significantly decreased length of stay and overall cost, without an increased rate of readmission.
authors.affiliation: Department of Pediatrics, New York Presbyterian-Hospital and Joan and Sanford Weill Medical College, Cornell University, New York, New York 10021, USA. awazeka@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Wazeka
authors.forename: D J
authors.initials: DJ
authors.lastname: Valacer
authors.forename: M
authors.initials: M
authors.lastname: Cooper
authors.forename: D W
authors.initials: DW
authors.lastname: Caplan
authors.forename: M
authors.initials: M
authors.lastname: DiMaio
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008511:Medicine; D010372:Pediatrics / Q000191:economics; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013038:Specialization