Multifaceted quality improvement initiative to decrease pediatric asthma readmissions

J Asthma. 2017 Nov;54(9):911-918. doi: 10.1080/02770903.2017.1281294. Epub 2017 Jan 24.


Background: Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years.

Methods: Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions.

Results: From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions.

Conclusion: A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.

Keywords: Pediatrics; barriers to care; control/management; hospitalization; multidisciplinary.

MeSH terms

  • Adolescent
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Patient Readmission / statistics & numerical data*
  • Quality Improvement*