title: Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals.
abstract: OBJECTIVE
  Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals.
  
  
  METHODS
  Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses.
  
  
  RESULTS
  At PCH, the CS increased and remained at >90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P = .026) and length of stay (P < .001), a trend toward reduced costs (P = .094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting >2 years after dissemination, with a slight but not significant readmission reduction (P = .119), a significant reduction in length of stay (P < .001) and cost (P = .053), a slight increase in hospital resource use (P = .032), and no change in ICU transfers or deaths.
  
  
  CONCLUSIONS
  Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and flory.nkoy@hsc.utah.edu.
authors.forename: Flory
authors.initials: F
authors.lastname: Nkoy
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fassl
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
authors.forename: Bryan
authors.initials: B
authors.lastname: Stone
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Uchida
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Joseph
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Reynolds
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Karen
authors.initials: K
authors.lastname: Valentine
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Karmella
authors.initials: K
authors.lastname: Koopmeiners
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
authors.forename: Eun Hea
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Lucy
authors.initials: L
authors.lastname: Savitz
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maloney
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D014589:Utah