title: Multifaceted quality improvement initiative to decrease pediatric asthma readmissions.
abstract: BACKGROUND
  Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years.
  
  
  METHODS
  Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions.
  
  
  RESULTS
  From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions.
  
  
  CONCLUSIONS
  A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Nadia L
authors.initials: NL
authors.lastname: Krupp
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Fiscus
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Webb
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.|b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Webber
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Stanley
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pettit
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Davis
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Hollingsworth
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bagley
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Marjorie
authors.initials: M
authors.lastname: McCaskey
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Stevens
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Weist
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: A Ioana
authors.initials: AI
authors.lastname: Cristea
authors.affiliation: b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Warhurst
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.|b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bauer
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Saysana
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Montgomery
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Howenstine
authors.affiliation: a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement
keywords: Pediatrics; barriers to care; control/management; hospitalization; multidisciplinary