The struggles of pediatric asthma

Pediatric asthma takes a heavy toll on patients and families alike. Though understanding how to care for these young patients has significantly improved in the last several decades, there are still some black spots that remain obscure.

The researchers from Children's National Health System explored and identified prospects about ways to keep young asthmatic patients out of hospitals.

"We know how to effectively treat pediatric asthma," said Kavita Parikh. "There's been a huge investment in terms of quality improvements that are reflected in how many papers there are about this topic in the literature."

However, Parikh noted, most of those quality-improvement papers do not focus on inpatient discharge, a particularly vulnerable time for patients. Up to 40 percent of children who are hospitalized for asthma-related concerns come back through the emergency department within one year. One-quarter of those kids are readmitted.

"It's clear that we need to do better at keeping kids with asthma out of the hospital. The point at which they're being discharged might be an effective time to intervene," Parikh added.

To determine which interventions hold promise, Parikh and colleagues recently performed a systematic review of studies involving quality improvements after inpatient discharge.

The researchers combed the literature, looking for research that tested various interventions at the point of discharge for their effect on hospital readmission anywhere from fewer than 30 days after discharge to up to one year later.

Their search netted 30 articles. A more thorough review of each of these studies revealed common themes to interventions implemented at discharge:

Nine studies focused on standardisation of care, such as introducing or revising a specific clinical pathway

Nine studies focused on education, such as teaching patients and their families better self-management strategies

Five studies focused on tools for discharge planning, such as ensuring kids had medications in-hand at the time of discharge or assigning a case manager to navigate barriers to care and

Seven studies looked at the effect of multimodal interventions that combined any of these themes.

When Parikh and colleagues examined the effects of each type of intervention on hospital readmission, they came to a stunning conclusion: No single category of intervention seemed to have any effect.