title: Multicenter analysis of quality indicators for children treated in the emergency department for asthma.
abstract: OBJECTIVE
  To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department.
  
  
  METHODS
  Investigators at 14 US sites prospectively enrolled consecutive children 2 to 17 years of age presenting to the emergency department with acute asthma. In models adjusted for variables commonly associated with the quality of acute asthma care, we measured the association between 7 measures of concordance with national asthma guideline-recommended processes and 2 outcomes. Specifically, we modeled the association between 5 receipt/nonreceipt process measures and successful discharge and the association between 2 timeliness measures and admission.
  
  
  RESULTS
  In this cohort of 1426 patients, 62% were discharged without relapse or ongoing symptoms (successful discharge), 15% were discharged with relapse or ongoing symptoms, and 24% were admitted. The composite score for receipt of all 5 receipt/nonreceipt process measures was 84%, and for timeliness measures, 57% receive a timely corticosteroid and 92% a timely β-agonist. Our adjusted models showed no association between process and outcome measures, with 1 exception: timely β-agonist administration was associated with admission, likely reflecting confounding by severity rather than a true process-outcome association.
  
  
  CONCLUSIONS
  We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.
authors.affiliation: Department Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Sills
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists