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

Md. Sharif, Shakirah and Ab Rahman, Jamalludin and Abdul Latif, Hasniah and Awang, Rus Anida and Daud, Mariana and Abdullah, Ahmad Fadzil and Sahadan, Dayang Zuraini and Choo, Su Siew and Zainal, Ramli and Hussain, Samsinah and Mohamed Zainuddin, Norzila (2019) Paediatric asthma clinical pathway: Impact on cost and quality of care. Medical Journal of Malaysia, 74 (2). pp. 138-144. ISSN 0300-5283

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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. © 2019, Malaysian Medical Association. All rights reserved.

Item Type: Article (Journal)
Additional Information: 3297/79752
Uncontrolled Keywords: Asthma, clinical pathway, outcomes, paediatric, cost
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Medicine
Depositing User: Dr Jamalludin Ab Rahman
Date Deposited: 23 Mar 2020 17:22
Last Modified: 25 Sep 2020 10:59
URI: http://irep.iium.edu.my/id/eprint/79752

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