Comparison of US emergency department acute asthma care quality: 1997-2001 and 2011-2012

• Published in: Journal of allergy and clinical immunology 2015-01, Vol.135 (1), p.73-80.e7
• Main Authors: Hasegawa, Kohei, MD, MPH, Sullivan, Ashley F., MPH, MS, Tsugawa, Yusuke, MD, MPH, Turner, Stuart J., BPharm, MPH, Massaro, Susan, PharmD, MPH, Clark, Sunday, ScD, Tsai, Chu-Lin, MD, ScD, Camargo, Carlos A., MD, DrPH
• Format: Article
• Language: English
• Subjects: Acute asthma; Adult; Allergy and Immunology; Asthma - therapy; concordance; emergency department; Emergency medical care; Emergency Service, Hospital - standards; Emergency Treatment - standards; Female; guideline; Guideline Adherence; hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Male; Middle Aged; Practice Guidelines as Topic; quality of care; Quality of Health Care - standards; regional variation; Studies; time trend; United States; Womens health
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2014.08.028

Background It remains unclear whether the quality of acute asthma care in US emergency departments (EDs) has improved over time. Objectives We investigated changes in concordance of ED asthma care with 2007 National Institutes of Health guidelines, identified ED characteristics predictive of concordance, and tested whether higher concordance was associated with lower risk of hospitalization. Methods We performed chart reviews in ED patients aged 18 to 54 years with asthma exacerbations in 48 EDs during 2 time periods: 1997-2001 (2 prior studies) and 2011-2012 (new study). Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores at the patient and ED levels; these scores ranged from 0 to 100. Results The analytic cohort comprised 4039 patients (2119 from 1997-2001 vs 1920 from 2011-2012). Over these 16 years, emergency asthma care became more concordant with level A recommendations at both the patient and ED levels (both P