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Physician Resource

New Initiative Ensures Best Practices in Asthma Care

At a Glance

  • UVA Children’s Hospital is part of a new effort called Pathways for Improving Pediatric Asthma Care (PIPA)
  • The goal is to decrease the use of unnecessary interventions for children with asthma
  • 89 participating hospitals will have access to a variety of tools to help guide decision-making
  • Best practices will be shared among participating hospitals and with referring providers

Asthma affects nearly 10 percent of American children and is a leading cause of pediatric emergency visits and hospitalizations. To ensure that children with asthma receive consistent, evidence-based care, the University of Virginia Children’s Hospital has joined a consortium of 89 hospitals, including several Virginia medical centers, in a nationwide effort to decrease the use of unnecessary interventions. The year-long initiative, Pathways for Improving Pediatric Asthma Care (PIPA), is being spearheaded by the American Academy of Pediatrics and Sunitha Kaiser, MD, MSc, FAAP.

“Physicians face tremendous barriers to consistently practicing evidence-based care. This leads to inappropriate variability in important outcomes for children with asthma, like rates of admission to hospitals and intensive care units. The goal of this project is to support hospitals around the country in addressing those barriers,” says Kaiser.

“The specific changes we make are designed to improve outcomes for patients and their families,” adds Eliza Holland, MD, the pediatric hospitalist leading the initiative at UVA. “The program will also ensure more uniform care, because many of the hospitals in Central Virginia that refer children to us will be following the same approach to treatment.” Besides UVA, the participating institutions are Centra Health, Augusta Health, VCU Health and Mary Washington Healthcare.

As part of this initiative, UVA will be informing referring physicians about PIPA, acquainting them with the practices encouraged by the program and sharing lessons learned. “Our hope is that physicians throughout the state, regardless of setting, will all be aware of the PIPA pathways,” Holland says.

Making Incremental Improvements in Treatment
The PIPA project will be conducted by the Value in Inpatient Pediatrics (VIP) Network. PIPA, like previous VIP Network projects, provides content and quality-improvement expert guidance within a low-cost virtual learning collaborative, leveraging health information technology. The project will offer tools to help healthcare providers select medications, order tests and effectively counsel families.

The VIP Network will disseminate sample order sets that UVA can adopt for its Epic electronic medical record system, which will help guide them in their decision-making. Clinicians from UVA’s emergency room and the inpatient wards will track such metrics as emergency room length of stay, hospital length of stay, time to first dose of steroids, prescription of antibiotics and use of X-rays. At the end of each month, team members will compare their performance with PIPA guidelines and, with the help of a coach, identify areas of additional improvement.

The team will also have the opportunity to learn from other PIPA hospitals about approaches that worked for them. The goal is to implement an asthma treatment plan at the hospital that is based in best practices.

Improving Quality of Life
Hospital care is not the only focus of PIPA. An equally important focus is ensuring that patients remain as healthy as possible once they return home. This includes educating family members about smoke exposure and providing tools and resources they can use to stop smoking. It also entails helping them switch from nebulizers to inhalers.

“Nebulizers are helpful for babies who cannot coordinate their breathing very well and for children who are having an especially difficult time,” Holland says. “For routine use, inhalers are a better option.” She notes that inhalers deliver a dose of albuterol in 30 to 60 seconds, rather than the 10 minutes it takes using a nebulizer.

The switch to inhalers benefits both family members and patients. Inhalers, unlike nebulizers, are portable and can be secured from a pharmacy rather than a medical supply company. “If we start using inhalers and spacers early during the hospitalization, respiratory therapists can work with families and teach them to use them properly,” Holland says. “The goal is to help them feel comfortable using them at home.”

Making sure that children remain in the emergency room and, if they are admitted, at the medical center only as long as necessary is another step UVA is taking as part of PIPA that can improve quality of life for patients and their families. “Many families live far from Charlottesville, and it is a strain socially and financially to be here,” Holland says. “We would like to enable patients to return to their homes safely and quickly.”

Shaping the Future of Asthma Care
During the course of the year, Holland expects the UVA team will gradually internalize the PIPA guidelines, though she stresses that the program is not a substitute for clinical decision-making. “Each patient is different and has different needs,” she says. “As a result, our focus is not on absolute targets, but on appropriate care.”

An often-overlooked advantage of quality improvement collaborations like PIPA, Holland points out, is its impact on residents. “As a result of their exposure to PIPA, we hope that our pediatric and emergency room residents will incorporate PIPA guidelines into their practice,” Holland says. “In this way, we will extend the benefits of the program into the future.”

To refer a patient to UVA Childern’s Hospital, call UVA Physician Direct at 800.552.3723.

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