Interventions to Decrease Pediatric Hospital Readmission for Asthma Patients Are Not Effective

Pediatric asthma affects more than 7 million children in the United States; however, although the knowledge and care for patients has increased over time, overall morbidity has not decreased during the last decade.

In a systematic review, published by the journal Pediatrics, researchers evaluated which interventions were effective at the point of discharge from the hospital for their effect on readmission from 30 days to 1 year after the initial discharge. Specifically, they evaluated literature from 1991—the year the National Institutes of Health issued its original asthma care guidelines—to November 2016.

According to Parikh, up to 40% of children who are hospitalized for asthma-related concerns come back through the emergency department within 1 year and one-fourth of those children are readmitted.

"It's clear that we need to do better at keeping kids with asthma out of the hospital," Kavita Parikh, MD, MSHS, a pediatric hospitalist at Children's National Health System, said in a statement. "The point at which they're being discharged might be an effective time to intervene."

The review considered different interventions implemented at discharge, including:

• Nine studies focused on standardization of care, such as introducing a specific clinical pathway
• Nine studies focused on education, such as teaching patients and their families better self-management methods
• Five studies focused on tools for discharge planning, such as ensuring children had medications in-hand at the time of discharge from the hospital
• Seven studies focused on the effect of multimodal interventions that combined any of these themes

The analysis revealed that no single category of intervention seemed to have any effect. Only the multimodal interventions that combined multiple categories were effective at reducing the risk of readmission between 30 days and 1 year after the initial discharge, according to the review.

"It's indicative of what we have personally seen in quality-improvement efforts here at Children's National," Parikh stated. "With a complex condition like asthma, it's difficult for a single change in how this disease is managed to make a big difference. We need complex and multimodal programs to improve pediatric asthma outcomes, particularly when there's a transfer of care like when patients are discharged and return home."

Overall, the results suggest that there is a need for improvement of the strategies and interventions in order to decrease readmission rates. Parikh called for stakeholders on the inpatient and outpatient side to be engaged in this effort to improve outcomes.