1.Paediatric asthma clinical pathway: Impact on cost and quality of care
Shakirah Md.Sharif ; 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
The Medical Journal of Malaysia 2019;74(2):138-144
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.