10 February, Washington D.C
A retrospective cohort study has found that readmission rates at three months for kids hospitalised for acute asthma dropped when families received comprehensive education prior to discharge from the hospital.
It has come to light that prior knowledge has proven to be the only component of discharge bundles that was strongly associated with lowered readmissions.
According to the Centres for Disease Control and Prevention, asthma is the most common chronic lung disease of childhood, affecting roughly 6 million U.S. children.
Children who are hospitalised for asthma have a roughly 20 percent chance of returning to the hospital in the next year, and individual hospital readmission rates can range from 5.7 percent to 9.1 percent at three months, wrote the study team.
“Improving how we care for children who are hospitalized with asthma includes preparing them for a successful return home with the best tools to manage their illness and prevent a future hospital visit,” said lead author Kavita Parikh.
Parikh added, “Our study underscores the importance of increasing the intensity of select discharge components. For example, ensuring that children hospitalized for asthma receive asthma medication at discharge along with comprehensive education and environmental mitigation may reduce asthma readmissions.”
The study team analysed records from a national sample of tertiary care children’s hospitals, looking at hospitalizations of 5- to 17-year-olds for acute asthma exacerbation during the 2015 calendar year.
They characterised how frequently hospitals used 13 separate asthma discharge components by distributing an electronic survey to quality leaders. Forty-five of 49 hospitals (92 percent) completed the survey.
The 45 hospitals recorded a median of 349 asthma discharges per year and had a median adjusted readmission rate of 2.6 percent at 30 days and a 6.6 percent median adjusted readmission rate at three months.
The most commonly used discharge components employed for children with asthma were having a dedicated person providing education (76 percent), providing a spacer at discharge (67 percent), and communicating with a primary medical doctor (58 percent).
Discharge components that were trending toward reduced readmission rates at three months included – Comprehensive asthma education, including having dedicated asthma educators; and Medications and devices provided to patients at discharge, such as spacers, beta-agonists, controller medication, and oral steroids.
Other components included – communication and scheduled appointments with a primary medical doctor and post-discharge activities, including home visits and referrals for environmental mitigation programs.
“In addition to being aligned with NIH asthma recommendations, connecting the family with a primary care provider and oral steroids at discharge helps to improve patients’ timely access to care if symptoms recur when they return home”, Dr. Parikh further noted.
“Bundling these discharge components may offer multiple opportunities to educate patients and families and to employ a range of communication styles such as didactic, visual and interactive”.
The findings of the study are published in The Journal of Pediatrics.