title: Quality of care for acute asthma in 63 US emergency departments.
abstract: BACKGROUND
  Little is known about the quality of acute asthma care in the emergency department (ED).
  
  
  OBJECTIVE
  We sought to determine the concordance of ED management of acute asthma with National Institutes of Health asthma guidelines, to identify ED characteristics predictive of higher guideline concordance, and to assess whether guideline concordance was associated with hospital admission.
  
  
  METHODS
  We conducted a retrospective chart review study of acute asthma as part of the National Emergency Department Safety Study. Using a principal diagnosis of asthma, we identified ED visits for acute asthma in 63 urban EDs in 23 US states between 2003 and 2006. Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores both at the patient and ED level. These scores ranged from 0 to 100, with 100 indicating perfect concordance.
  
  
  RESULTS
  The cohort consisted of 4,053 subjects; their median age was 34 years, and 64% were women. The overall patient guideline concordance score was 67 (interquartile range, 63-83), and the ED concordance score was 71 (SD, 7). Multivariable analysis showed southern EDs were associated with lower ED concordance scores (beta-coefficient, -8.2; 95% CI, -13.8 to -2.7) compared with northeastern EDs. After adjustment for the severity on ED presentation, patients who received all recommended treatments had a 46% reduction in the risk of hospital admission compared with others.
  
  
  CONCLUSIONS
  Concordance with treatment recommendations in the National Institutes of Health asthma guidelines was moderate. Significant variations in ED quality of asthma care were found, and geographic differences existed. Greater concordance with guideline-recommended treatments might reduce hospitalizations.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Tsai
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: James A
authors.initials: JA
authors.lastname: Gordon
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: David
authors.initials: D
authors.lastname: Blumenthal
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000628:therapy*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States