Adherence to Asthma Guidelines at a Tertiary Center

Asthma related hospitalizations remain the single most common reason for admissions among children despite the availability and dissemination of guidelines for diagnosis and treatment of asthma. The objective of this study is to evaluate patients admitted to a pediatric tertiary care center for asthma exacerbation who received care according to the National Heart Lung and Blood Institute Expert Panel Review 3 (NHLBI-EPR 3) asthma guidelines after hospitalization. Retrospective analysis of 108 pediatric patients who were hospitalized at LAC+USC Medical Center (LUMC) for asthma exacerbations during a two year period from May 1st, 2013 to May 1st, 2015. Inclusion criteria comprised of patients with a primary diagnosis of asthma, admission to LUMC and ages 3-21. Patients outside this age, with a co-diagnosis of bronchitis, congenital heart disease, cystic fibrosis, renal disease and immunodeficiency were excluded from the study. 102 patients met these criteria. 85.3 % (87/102) of patients received appropriate guideline based care and 26.5% (27/102) of these patients were seen by an asthma specialist. Guideline based care was defined as patients who received the appropriate dose and controller medications 85.3% (87/102), asthma education 86% (88/102), asthma action plan 87.3% (89/102) and follow up appointment 86.2% (88/102). Results demonstrated significant adherence to asthma guidelines in treatment of asthmatic children at LUMC. Possible factors contributing to adherence to guidelines include, allergy specialists attending on pediatric wards, allergy consultants and house-staff allergy rotations. Understanding and applying the factors that contributed to provider success may overall increase provider adherence to guidelines at other institutions.