Evaluation of the Emergency Department Asthma Care Project

NCT00268580 | Completed

• 2 other identifiers: DMED-782-04ORS # 2003-342
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 8

Brief Summary

The purpose of the study is to evaluate whether the Emergency Department (ED) Asthma Care Project (ACP) leads to improved asthma care delivery and patient outcomes in the ED setting. Hypothesis: Implementation of a multi-disciplinary asthma strategy/clinical pathway for the treatment of asthma in the ED, based upon the 1999 Canadian Asthma Consensus Guidelines (and subsequent updates), will increase adherence with published management guidelines in the ED setting, reduce variations in the emergency management of acute asthma, increase utilization of specialized asthma services and improve outcomes for patients following ED visits. Methods: This observational, pre- post-intervention study will compare a stratified sample of 10 Ontario hospital EDs (5 intervention and 5 control sites). Chart abstractions will be performed on all adult visits for acute asthma over a 3 month period before and after implementation of the Ontario Hospital Associations (OHA)'s (now Ontario Lung Association's (OLA's) ED Asthma Care Map. Patient and provider surveys and provider focus group post intervention will also be conducted. Primary outcome measures are hospitalizations and repeat ED visit rates. Secondary outcome measures include: length of stay in ED, self-reported adherence with referral to specialized asthma services made during index ED visit, self-reported asthma control, and use of self-management strategies (including use of action plan), use of asthma management strategies promoted by the care map (such as use of objective measure of airflow rates, use of steroids, education, referral to specialized asthma services on discharge). Ease of implementation and barriers to implementation will also be evaluated.

Conditions

Asthma

Keywords

Asthma; Care map; Clinical pathway; Education; Emergency department

Outcome Measures

Primary Outcomes (2)

• % of ED visitors admitted to hospital for asthma

  The patient is either admitted or not at the end of the ED visit.

  At the end of the index ED visit (this is a dichotomous outcome. It is not possible to specify a "time frame").

• Repeat Emergency Department visit rate for asthma

  Within 24, 72h, 1 month

Secondary Outcomes (16)

• Hospitalization length of stay

  From ED presentation to hospital discharge

• Length of stay in ED

  From ED presentation to ED discharge

• Self-reported adherence with referral to specialized asthma services made during index ED visit

  At folllowup questionnaire

• Self-reported asthma control, and use of self-management strategies (including use of action plan)

  At followup questionnaire

• Use of Asthma Management Strategies Promoted by the ED ACP: use of objective measure of airflow rates (PEFR or spirometry), and gas exchange (oxygen saturation, arterial blood gases)

  During index ED visit (between ED presentation and ED discharge).

Study Arms (2)

Intervention

EXPERIMENTAL

Asthma care provided using care pathway

Behavioral: Asthma Care Pathway

Control

NO INTERVENTION

Standard of care provided

Interventions

Asthma Care Pathway BEHAVIORAL

Asthma care provided using standardized asthma care pathway

Intervention

Eligibility Criteria

• Age: 19 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• asthma plus or minus chronic obstructive pulmonary disease (COPD)
• ED visit for acute asthma treatment
• age 19 years or greater

You may not qualify if:

• COPD without asthma
• ED visit for asthma prescription renewal only

Sponsors & Collaborators

• Queen's University: lead
• Ontario Hospital Association: collaborator
• Ontario Ministry of Health and Long Term Care: collaborator

Study Sites (8)

Chatham Kent Health Alliance

Chatham, Ontario, N7M 5L9, Canada

Location

Sudbury Regional Hospital

Greater Sudbury, Ontario, P3E 5J1, Canada

Location

St. Joseph's Healthcare

Hamilton, Ontario, L8N 4A6, Canada

Location

Lake of the Woods District Hospital

Kenora, Ontario, P9N 3W7, Canada

Location

Lakeridge Health Hospital

Oshawa, Ontario, L1J 8R2, Canada

Location

Grey Bruce Health Services

Owen Sound, Ontario, N4K 6M9, Canada

Location

Prince Edward County Hospital

Picton, Ontario, Canada

Location

Renfrew Victoria Hospital

Renfrew, Ontario, K7V 1P6, Canada

Location

MeSH Terms

Conditions

Asthma; Emergencies

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Diane Lougheed, MD

  Queen's University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: December 20, 2005
• First Posted: December 22, 2005
• Study Start: January 1, 2006
• Primary Completion: January 1, 2006
• Study Completion: June 1, 2006
• Last Updated: March 29, 2016

Record last verified: 2016-03

Locations

CA (8)