Improved outcomes for hospitalized asthmatic children using a clinical pathway

Background: Although asthma clinical pathways are used with increasing frequency, few controlled studies have evaluated the clinical and cost effectiveness of these pathways. Objective: To evaluate the effect of an inpatient asthma clinical pathway on cost and quality of care for children with asthma. Methods: One hundred forty-nine children were treated for status asthmaticus using an asthma clinical pathway in a children's hospital between September and December 1997. Thirty-four of 149 children treated with the clinical pathway were randomly selected. A retrospective cohort control group of non-pathway patients (N = 34) was matched with each pathway patient by age, race, gender, comorbidities, asthma severity score, ICU admission, and time of year admitted. Differences between the two groups in length of stay, total costs, readmission rate, inpatient management, and discharge medications were compared. Results: Length of stay was significantly lower in the clinical pathway group compared with the control group (36 hours versus 71 hours, P <.001) and total costs decreased significantly ($1685 versus $2829, P <.001) as a result of the pathway. Asthmatic children on the clinical pathway were significantly more likely than the control group to complete asthma teaching while hospitalized (65% versus 18%, P <.001), to be discharged with a prescription for a controller medication (88% versus 53%, P <.01), and to have a peak flow meter (57% versus 23%, P <.05) and a spacer device (100% versus 71%, P <.001) for home use. Conclusion: Implementation of this inpatient clinical pathway led to a decrease in length of stay and a reduction in total cost while improving quality of care for hospitalized asthmatic children.