Published Online: September 26, 2014
Acute asthma continues to be a substantial health burden in the U.S., accounting for 1.8 million emergency department (ED) visits and 440,000 hospitalizations annually. Concordance of healthcare delivery with quality measures has improved over time in several disease conditions, such as heat attack and pneumonia. However, changes in the quality of emergency asthma care have attracted less attention.
In an article recently published in The Journal of Allergy and Clinical Immunology, Hasegawa and colleagues investigated changes in concordance of acute asthma management in 48 EDs with the recommendations in the 2007 NIH asthma guidelines over a period of 16 years. The authors conducted chart reviews in ED adult patients with acute asthma during two time periods – 1997-2001 (two prior studies) and 2011-2012 (new study) – and evaluated concordance with the guideline recommendations.
In this 48-center analysis, based on three observational studies of 4,039 adults with acute asthma over 16 years, the researchers found changes in quality of emergency asthma care that differed by level of guideline recommendation. While emergency care became highly concordant with the level-A guideline recommendations (e.g., use of inhaled anticholinergics and systemic corticosteroids in the ED), the concordance with non-level-A recommendations (i.e., use of peak flow measurement and timeliness measures) declined. Additionally, the variations in these measures became larger across the EDs, with significant regional differences. The data also demonstrated a strong association between quality of care and patient outcomes. Specifically, complete concordance with the NIH guidelines was associated with a significantly reduced risk of hospitalization.
Based on the observational studies of acute asthma in 48 U.S. EDs, the researchers found changes in quality of emergency asthma care that differed by level of guideline recommendation. The observed improvement in the concordance with level-A guideline recommendations supports prior optimism that the quality of emergency asthma care can be improved and the morbidity reduced. In contrast, the decreased concordance with non-level-A recommendations and wide inter-hospital variations in quality of care present an important challenge. For researchers, these observations should facilitate further investigation to build more robust evidence on the current non-level-A recommendations. The data also demonstrated the strong association between fully concordant asthma care and a lower risk of hospitalization. To achieve better patient outcomes, clinicians and policy makers will need to promote further adoption of level-A recommendations and assist efforts to decrease the inter-hospital variations in quality of emergency asthma care.
The Journal of Allergy and Clinical Immunology (JACI) is an official journal of the AAAAI, focusing on practical information for the practicing clinician.