Paediatric asthma clinical pathway: Impact on cost and quality of care

Shakirah Mdsharif; Jamalludin Ab Rahman; Hasniah Abdul Latif; Rus Anida Awang; Mariana Daud; Ahmad Fadzil Abdullah; Dayang Zuraini Sahadan; Su Siew Choo; Ramli Zainal; Samsinah Hussain; Norzila Mohamed Zainudin

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Paediatric asthma clinical pathway: Impact on cost and quality of care

Author: Shakirah Md.Sharif ¹ ; Jamalludin Ab Rahman ² ; Hasniah Abdul Latif ³ ; Rus Anida Awang ⁴ ; Mariana Daud ⁵ ; Ahmad Fadzil Abdullah ⁶ ; Dayang Zuraini Sahadan ⁷ ; Su Siew Choo ⁸ ; Ramli Zainal ⁹ ; Samsinah Hussain ¹⁰ ; Norzila Mohamed Zainudin ¹¹
Author Information

1. Institute for Health Systems Research, National Institutes of Health, Shah Alam, Selangor
2. Kuliyyah of Medicine, International Islamic University of Malaysia, Selangor, Malaysia
3. Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
4. Department of Paediatrics, Hospital Pulau Pinang, Penang, Malaysia
5. Department of Paediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
6. Department of Paediatrics, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
7. Department of Paediatrics, Hospital Serdang, Kajang, Selangor, Malaysia
8. Department of Paediatrics, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
9. National Pharmaceutical Regulatory Agency, Petaling Jaya, Selangor, Malaysia
10. 0 Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
11. 1 Paediatric Institute Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Publication Type:Journal Article
Keywords: Asthma; clinical pathway; outcomes; paediatric, cost
From: The Medical Journal of Malaysia 2019;74(2):138-144
CountryMalaysia
Language:English
Abstract: INTRODUCTION: Uncontrolled asthma may cause an increase in healthcare utilisation, hospital admission and productivity loss. With the increasing burden of asthma in Malaysia, strategies aimed at reducing cost of care should be explored. OBJECTIVE: This study aims to determine if a clinical pathway (CPW) for inpatient paediatric asthma would reduce average length of stay (ALOS), improve asthma management and decrease cost. METHODS: A quasi-experimental, pre-post study was used to evaluate the CPW effectiveness. Paediatric inpatients aged 5-18 years old, admitted for acute asthma exacerbation from September 2015 to April 2016 were prospectively recruited. Data from patients admitted from January-July 2015 were used as control. CPW training was carried out in August 2015 using standardised modules. Direct admission cost from the provider's prospective was calculated. Outcomes compared were differences in ALOS, discharge medication, readmission within 28 days of discharge and cost. RESULTS: ALOS is 26 hours lower in the CPW group for severe exacerbations and underlying uncontrolled asthma (19.2 hours) which is clinically significant as patients have shorter hospital stay. More newly-diagnosed intermittent asthmatics were discharged with relievers in the CPW group (p-value 0.006). None of the patients in the CPW group had readmissions (p-value 0.16). Mean treatment cost for patients in the intervention group is higher at RM843.39 (SD ±48.99, versus RM779.21 SD±44.33). CONCLUSION: This study found that management using a CPW may benefit asthmatic patients with uncontrolled asthma admitted with severe exacerbation. Further studies will be needed to explore CPW's impact on asthma management starting from the emergency department.
Full text:6.2019.my1405.pdf