Reviews and feature articleQuality of care for acute asthma in 63 US emergency departments
Section snippets
Study design and setting
This retrospective cohort study was part of the NEDSS. Details of the study design and data collection have been published previously.18 In brief, the NEDSS was a large multicenter study that sought to characterize organizational- and clinician-related factors associated with the occurrence of errors in EDs. NEDSS was coordinated by the Emergency Medicine Network (EMNet; www.emnet-usa.org). We recruited EDs mainly by inviting sites affiliated with the EMNet. Because most EMNet sites are
Results
A total of 6,065 visits with a principal diagnosis of asthma were identified on the basis of ICD-9-CM codes, and the charts were reviewed. A total of 2,015 visits were excluded because of age of 13 years or less (n = 712), age of 55 years or greater (n = 490), history of chronic obstructive pulmonary disease (n = 177), no history of chronic asthma (n = 377), visits not prompted by asthma exacerbation (n = 289), and missing information on inclusion/exclusion criteria (n = 7). The final cohort
Discussion
In this study of 4,053 patients presenting to 63 EDs with acute asthma, we found that the overall concordance of emergency care with guideline recommendations was moderate. However, emergency care for asthma was highly concordant with guideline recommendations that are based on the stronger evidence (ie, level A evidence). There were substantial variations in the ED quality of care in different geographic regions, with the widest gap between the South and the Northeast. Our study also showed a
References (38)
- et al.
Improved overall trends but persistent racial disparities in emergency department visits for acute asthma, 1993-2005
J Allergy Clin Immunol
(2008) - et al.
Use of the health plan employer data and information set for measuring and improving the quality of asthma care
Ann Allergy Asthma Immunol
(2006) - et al.
Physician adherence to the national asthma prescribing guidelines: evidence from national outpatient survey data in the United States
Ann Allergy Asthma Immunol
(2008) - et al.
Asthma quality-of-care markers using administrative data
Chest
(2005) - et al.
Quality and access to care among a cohort of inner-city adults with asthma: who gets guideline concordant care?
Chest
(2005) - et al.
Predicted peak expiratory flow: differences across formulae in the literature
Am J Emerg Med
(2004) - et al.
A prospective multicenter study of factors associated with hospital admission among adults with acute asthma
Am J Med
(2002) - et al.
Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma?
Respir Med
(2004) - et al.
The quality of obstructive lung disease care for adults in the United States as measured by adherence to recommended processes
Chest
(2006) - et al.
Effect of an emergency department asthma program on acute asthma care
Ann Emerg Med
(1999)
National surveillance for asthma—United States, 1980-2004
MMWR Surveill Summ
Healthy people 2010. 2nd ed. With understanding and improving health and objectives for improving health. Section 24: respiratory diseases
Expert panel report: guidelines for the diagnosis and management of asthma
Expert panel report ii: guidelines for the diagnosis and management of asthma
Expert panel report: guidelines for the diagnosis and management of asthma update on selected topics—2002
J Allergy Clin Immunol
Expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma—summary report 2007
J Allergy Clin Immunol
Crossing the quality chasm: a new health system for the 21st century
Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: results of the Emergency Department Quality in Myocardial Infarction (EDQMI) study
Circulation
Cited by (0)
Supported by grant no. 5 R01 HS013099 from the Agency for Healthcare Research and Quality (Rockville, Md). Dr Camargo also is funded by grant HL084401 (Bethesda, Md).
Disclosure of potential conflict of interest: R. Kaushal received grant support from the Agency for Healthcare Research and Quality, the New York State Department of Health, the Commonwealth Fund, and the United Hospital Fund and has provided legal consultation services/expert witness testimony in cases related to medication errors. D. Blumenthal receives grant support from General Electric and is a member of the Pfizer Health Policy Board and Wellpoint Physician Advisory Committee. C. A. Camargo is a consultant for AstraZeneca, Clinical Therapeutics, and Novartis; is on the speakers' bureau for AstraZeneca, GlaxoSmithKline, and Merck; is on the advisory board for Dey, Genentech, GlaxoSmithKline, Merck, Novartis, and Schering-Plough; and receives grant support from the National Institutes of Health, AstraZeneca, Critical Therapeutics, GlaxoSmithKline, Merck, Novartis, and Respironics. The rest of the authors have declared that they have no conflict of interest.
Partial results from this study were presented at the 2008 Society for Academic Emergency Medicine Annual Meeting, Washington, DC, May 29–June 1, 2008.
Reprints will not be available from the authors.