title: Quality of care for acute asthma in emergency departments in Japan: a multicenter observational study.
abstract: BACKGROUND
  Little is known about the quality of acute asthma care in emergency departments (EDs) outside of North America.
  
  
  OBJECTIVE
  We evaluated concordance of acute asthma management in Japanese EDs with recommendations in the 2007 National Institutes of Health asthma guidelines and investigated whether guideline concordance was associated with risk of hospital admission.
  
  
  METHODS
  We conducted a multicenter chart review study in 23 EDs across Japan. We identified ED patients aged 18 to 54 years with acute asthma between 2009 and 2011. Concordance with evidence-based guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores both at patient and ED levels. These scores ranged from 0 to 100.
  
  
  RESULTS
  Among 1380 patients, the median age was 35 years and 11% were hospitalized. Overall guideline concordance score was suboptimal both at the patient level (mean ± SD, 72 ± 14) and ED level (mean ± SD, 72 ± 6). Specifically, asthma care at the patient level was suboptimal in several areas: inhaled anticholinergics in ED (2%), systemic corticosteroid in ED (56%) and at discharge (36%), and peak flow assessment (9%). A multivariable model that adjusted for severity at presentation and several ED characteristics showed that higher guideline concordance was associated with significantly lower risk of hospital admission (odds ratio, 0.70 per 10-unit increase in composite score; 95% CI, 0.62-0.79 per 10-unit increase in composite score).
  
  
  CONCLUSIONS
  The management of acute asthma in Japanese EDs is suboptimal. Greater concordance with guideline-recommended management might reduce unnecessary hospitalizations. Knowledge translation initiatives are warranted to increase adherence with best practice in acute asthma management.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: khasegawa1@partners.org.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Emergency Medicine, Obama Municipal Hospital, Obama, Fukui, Japan.
authors.forename: Takuyo
authors.initials: T
authors.lastname: Chiba
authors.affiliation: Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hagiwara
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Ore.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watase
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Mass; Center for Clinical Epidemiology of St Luke's Life Science Institute, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsugawa
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D011787:Quality of Health Care; D014970:Xanthines / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents; D018680:Cholinergic Antagonists; D014970:Xanthines; C008514:methylxanthine
keywords: Acute asthma; Emergency department; Guidelines; Hospitalization; Quality of care