Hospital-Initiated Care Bundle, Posthospitalization Care, and Outcomes in Adults with Asthma Exacerbation

Makiko Nanishi; Valerie G Press; Joseph B Miller; Carly Eastin; Taruna Aurora; Erin Crocker; Michimasa Fujiogi; Carlos A Camargo Jr; Kohei Hasegawa

doi:10.1016/j.jaip.2021.06.044

Hospital-Initiated Care Bundle, Posthospitalization Care, and Outcomes in Adults with Asthma Exacerbation

J Allergy Clin Immunol Pract. 2021 Nov;9(11):4007-4013.e8. doi: 10.1016/j.jaip.2021.06.044. Epub 2021 Jul 12.

Authors

Makiko Nanishi¹, Valerie G Press², Joseph B Miller³, Carly Eastin⁴, Taruna Aurora⁵, Erin Crocker⁶, Michimasa Fujiogi⁶, Carlos A Camargo Jr⁶, Kohei Hasegawa⁶

Affiliations

¹ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: mnanishi@mgh.harvard.edu.
² Department of Medicine, University of Chicago Medical Center, Chicago, Ill.
³ Department of Emergency Medicine, Henry Ford Hospital, Detroit, Mich.
⁴ Department of Emergency Medicine, University of Arkansas for Medical Science, Little Rock, Ark.
⁵ Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Va.
⁶ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

PMID: 34265445
DOI: 10.1016/j.jaip.2021.06.044

Abstract

Background: Hospitalization for asthma exacerbation is an opportune setting for initiating preventive efforts. However, hospital-initiated preventive asthma care remains underdeveloped and its effectiveness is uncertain.

Objective: To examine the effectiveness of a hospital-initiated asthma care bundle on posthospitalization asthma care and clinical outcomes.

Methods: Prospective multicenter study of adults (18-54 years) hospitalized for asthma exacerbation in 2017 to 2019. During the hospitalization, we implemented an asthma-care bundle (inpatient laboratory testing, asthma education, and discharge care), and prospectively measured chronic asthma care (eg, immunoglobulin E testing, specialist care) and asthma exacerbation (ie, systemic corticosteroid use, emergency department [ED] visit, hospitalizations) outcomes. By applying a self-controlled case series method, we examined within-person changes in these outcomes before (2-year period) and after (1-year period) the bundle implementation.

Results: Of 103 adults hospitalized for asthma exacerbation, the median age was 40 years and 72% were female. Compared with the preimplementation period, the postimplementation period had improved posthospitalized asthma care, including serum specific immunoglobulin E testing (rate ratio [RR] 2.18; 95% confidence interval [95% CI] 0.99-4.84; P = .051) and evaluation by asthma specialist (RR 2.66; 95% CI 1.77-4.04; P < .001). Likewise, after care bundle implementation, patients had significantly lower annual rates of systemic corticosteroid use (4.2 vs 2.9 per person-year; RR 0.70; 95% CI 0.61-0.80; P < .001), ED visits (3.2 vs 2.7 per person-year; RR 0.83; 95% CI 0.72-0.95; P = .008), and hospitalizations (2.1 vs 1.8 per person-year; RR 0.82; 95% CI 0.69-0.97; P = .02). Stratified analyses by sex, race and ethnicity, and health insurance yielded consistent results.

Conclusions: After hospital-initiated care bundle implementation, patients had improved posthospitalization care and reduced rates of asthma exacerbation.

Keywords: Asthma exacerbation; Asthma management; Hospitalization; Outcomes; Quality of care.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Asthma* / epidemiology
Asthma* / therapy
Female
Hospitalization
Hospitals
Humans
Patient Care Bundles*
Prospective Studies