Evaluation of the Emergency Department Asthma Care Project
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The purpose of the study is to evaluate whether the Emergency Department (ED) Asthma Care Project leads to improved asthma care delivery and patient outcomes in the ED setting.
Hypothesis: Implementation of a multi-disciplinary asthma strategy/clinical pathway for the treatment of asthma in the ED, based upon the 1999 Canadian Asthma Consensus Guidelines (and subsequent updates), will increase adherence with published management guidelines in the ED setting, reduce variations in the emergency management of acute asthma, increase utilization of specialized asthma services and improve outcomes for patients following ED visits.
Methods:
This observational, pre- post-intervention study will compare a stratified sample of 10 Ontario hospital EDs (5 intervention and 5 control sites). Chart abstractions will be performed on all adult visits for acute asthma over a 3 month period before and after implementation of the OHA’s ED Asthma Care Map. Patient and provider surveys and provider focus group post intervention will also be conducted. Primary outcome measures are hospitalizations and repeat ED visit rates. Secondary outcome measures include: length of stay in ED, self-reported adherence with referral to specialized asthma services made during index ED visit, self-reported asthma control, and use of self-management strategies (including use of action plan), use of asthma management strategies promoted by the care map (such as use of objective measure of airflow rates, use of steroids, education, referral to specialized asthma services on discharge). Ease of implementation and barriers to implementation will also be evaluated.
Condition | Intervention |
---|---|
Asthma |
Behavioral: Clinical pathway for asthma in the emergency department |
Study Type: | Interventional |
Study Design: | Allocation: Non-Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label |
Official Title: | Evaluation of the Emergency Department Asthma Care Project |
- % of ED visitors admitted to hospital for asthma
- Repeat Emergency Department visit rate for asthma
- Hospitalization rate and length of stay
- Length of stay in ED
- Relapse rate to the ED for asthma, within 24 and 72 hours of ED visit
- Self-reported adherence with referral to specialized asthma services made during index ED visit
- Self-reported asthma control, and use of self-management strategies (including use of action plan)
- Use of Asthma Management Strategies Promoted by the ED ACP: use of objective measure of airflow rates (PEFR or spirometry), and gas exchange (oxygen saturation, arterial blood gases)
- ; types of asthma medications prescribed (bronchodilators, corticosteroids) in ED and upon discharge; route of medications prescribed (IV vs oral vs. inhaled steroids; MDI vs nebulized bronchodilators)
- ; documentation of assessment and teaching of device technique
- ; documentation of asthma action plan provision or revision
- ; type of asthma education provided (e.g. environmental trigger avoidance, warning signs, medication use)
- ; follow-up care recommendations or referrals (AEC, Asthma Clinic, Respirology Clinic, family physician)
- Utilization of Specialized Asthma Services
- ; referral rates (#/year) to local AECs and Asthma Clinics
- ; types of providers involved in emergency asthma care
- Proportion of patients enrolled on the ED ACP (Overall, by patient age category and by physician specialty)
- Differences in patient demographics, physician demographics, day of week, time of day between patients enrolled vs. not enrolled
- Perceived utility of pathway (overall, by site, and by profession)
Estimated Enrollment: | 300 |
Study Start Date: | January 2006 |
Study Completion Date: | June 2006 |
Ages Eligible for Study: | 19 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- asthma plus or minus COPD
- ED visit for acute asthma treatment
- age 19 years or greater
Exclusion Criteria:
- COPD without asthma
- ED visit for asthma prescription renewal only
Canada, Ontario | |
Chatham Kent Health Alliance | |
Chatham, Ontario, Canada, N7M 5L9 | |
St. Joseph's Healthcare | |
Hamilton, Ontario, Canada, L8N 4A6 | |
Lake of the Woods District Hospital | |
Kenora, Ontario, Canada, P9N 3W7 | |
Lakeridge Health Hospital | |
Oshawa, Ontario, Canada, L1J 8R2 | |
Grey Bruce Health Services | |
Owen Sound, Ontario, Canada, N4K 6M9 | |
Prince Edward County Hospital | |
Picton, Ontario, Canada | |
Renfrew Victoria Hospital | |
Renfrew, Ontario, Canada, K7V 1P6 | |
Sudbury Regional Hospital | |
Sudbury, Ontario, Canada, P3E 5J1 |
Principal Investigator: | Diane Lougheed, MD | Queen's University |
No publications provided
ClinicalTrials.gov Identifier: | NCT00268580 History of Changes |
Other Study ID Numbers: | DMED-782-04, ORS # 2003-342 |
Study First Received: | December 20, 2005 |
Last Updated: | June 1, 2007 |
Health Authority: | Canada: Ethics Review Committee |
Keywords provided by Queen's University:
Asthma Care map Clinical pathway Education Emergency department |
Additional relevant MeSH terms:
Asthma Emergencies Bronchial Diseases Respiratory Tract Diseases Lung Diseases, Obstructive Lung Diseases |
Respiratory Hypersensitivity Hypersensitivity, Immediate Hypersensitivity Immune System Diseases Disease Attributes Pathologic Processes |
ClinicalTrials.gov processed this record on October 16, 2012