title: Modification of an Established Pediatric Asthma Pathway Improves Evidence-Based, Efficient Care.
abstract: In September 2011, an established pediatric asthma pathway at a tertiary care children's hospital underwent significant revision. Modifications included simplification of the visual layout, addition of evidence-based recommendations regarding medication use, and implementation of standardized admission criteria. The objective of this study was to determine the impact of the modified asthma pathway on pathway adherence, percentage of patients receiving evidence-based care, length of stay, and cost.
  
  
  
  Cases were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Data were analyzed for 24 months before and after pathway modification. Statistical process control was used to examine changes in processes of care, and interrupted time series was used to examine outcome measures, including length of stay and cost in the premodification and postmodification periods.
  
  
  
  A total of 5584 patients were included (2928 premodification; 2656 postmodification). Pathway adherence was high (79%-88%) throughout the study period. The percentage of patients receiving evidence-based care improved after pathway modification, and the results were sustained for 2 years. There was also improved efficiency, with a 30-minute (10%) decrease in emergency department length of stay for patients admitted with asthma (P = .006). There was a nominal (<10%) increase in costs of asthma care for patients in the emergency department (P = .04) and no change for those admitted to the hospital.
  
  
  
  Modification of an existing pediatric asthma pathway led to sustained improvement in provision of evidence-based care and patient flow without adversely affecting costs. Our results suggest that continuous re-evaluation of established clinical pathways can lead to changes in provider practices and improvements in patient care.
authors.affiliation: University of Washington, Seattle, Washington; lori.rutman@seattlechildrens.org.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Lori
authors.initials: L
authors.lastname: Rutman
authors.affiliation: Kaiser Permanente, Maui, Hawaii.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Atkins
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Russell
authors.initials: R
authors.lastname: Migita
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Foti
authors.affiliation: Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Spencer
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: K Casey
authors.initials: KC
authors.lastname: Lion
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Davene R
authors.initials: DR
authors.lastname: Wright
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Leu
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics