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UPDATE ON THE ALBERTA CHILDHOOD
ASTHMA PATHWAY
March 30, 2015
Overview • Broad Goals and Historical Background
• Why a pathway? • IN THE BEGINNING: Calgary Health Region • BECOMING ONE: Alberta Health Services
• ED and Inpatient Management Algorithms • Key pathway components • NEARING THE END: Pathway implementation • Pathway success
• Primary Care Algorithm • LONG TIME COMING: EMR based • Rigorous evaluation • Alberta-wide rollout?
BROAD GOALS AND HISTORICAL BACKGROUND
Why use a pathway? • Gap between best evidence and practice
• Variability in care delivered • Good evidence for both chronic and acute management
• Good care improves QOL, burden on family and health
care costs
IN THE BEGINNING: Calgary Health Region • Confluence of interest in developing acute care pathway
• Development of pathway 2004-6
• Implement ACH 2006 & remainder of Region by 2007/8
• Formal evaluation funded by CIHR
• Improved use of best therapies
• No decrease in health care utilization
BECOMING ONE: Alberta Health Services • Four Regions had acute asthma pathways • Prioritized by AHS Child Health Administration • Part of AHS Integration Teams
• Incorporation of primary care as well as acute care pathways
• Funded by CIHR Partners for Health Service Improvements
• Transferred to Respiratory Clinical Networks
ED AND INPATIENT MANAGEMENT ALGORITHMS
Development of AHS Acute Care Pathway • ED & Inpatient pathways developed 2010-2012
• Broad Alberta Representation
• Nurses, RTs, Pharmacists, Physicians • Rural, Urban, Both Children’s Hospitals
• Wide vetting across province
Pathway Components • ED Algorithm
• Validated clinical score • Use by nurses & RTs
• MDI with spacers in place of nebulizers • Advocating asthma education
• Various Tools • Standardized ED physician order set • Standardized ED documentation form • Patient Education Checklist • Pediatric Asthma Discharge Prescription, Short-Term Plan, &
Education Pamphlet • Coordinate Care between Acute Care Facilities and Community
Physicians
FOR HEALTH CARE STAFF
Web-based learning module {www.AHSchildhoodpathways.com}
Continuing Education Credit
Patient/family education • Evidence: Cochrane SR, 2009. • 38 RCTs, 7,843 children, educational interventions directed at
children and/or parents who present to ED • Subsequent ED visit, RR 0.73, 95% CI 0.65 to 0.81 • Hosp admission, RR 0.79, 95% CI 0.69 to 0.92 • Unscheduled MD visit, RR 0.68, 95% CI 0.57 to 0.81
• At discharge from ED or hospital: “Refer to the highest level of education available”
NEARING THE END: Pathway implementation
Sites • Covenant as well! • Inpatient Units (8 totlal)
• ACH & Stollery • PLC in-patient unit • Regional centres
• Emergency Departments (105 total)
• Urgent Care Centres (8 total in Calgary and Edmonton)
Timeline/Success • Pilot Fall 2012
• Last site May 2015
• First SCN project rolled
out provincially
Pathway Evaluation Medicine Hat/Brooks • ↑ MDI/spacers
• ↑ optimal therapies
• No ∆ asthma education
• No ∆ admit rate or LOS
Other Zones/sites?
PRIMARY CARE ALGORITHM
LONG TIME COMING • Lead by Andrew Cave, FP Edmonton
• No existing pathways
• Is it simple enough?
• The ‘right format’? EMR-based
• Substantial consolation
EMR Screen Shot • Med Access
• Standard scenarios
• Diagnosis • Phenotypes
• Follow-up
• Exacerbation
Rigorous evaluation – AIHS PRIHS • “Partnerships for Research and Innovation in the Health
System “
• Compare standard care vs EMR-based pathway/asthma education
• Cluster controlled trial: 22 primary care practices
• “Canadian Primary Care Sentinel Surveillance Program”
• “Health Quality Council of Alberta”
Rigorous evaluation – AIHS PRIHS Outcomes (admin data and standardized surveys))
• Increase anti-inflammatory medications? Prescriptions Dispensing
• Decrease health care utilization? • Increase family and child QOL and disease control? • Decrease in health care costs?
Alberta-wide rollout? • ~ 1200 total primary care practices
• 41 PCNs
SUMMARY
QUESTIONS?