Asthma Clinical Trial
Official title:
Evaluation of the Emergency Department Asthma Care Project
Verified date | March 2016 |
Source | Queen's University |
Contact | n/a |
Is FDA regulated | No |
Health authority | Canada: Ethics Review Committee |
Study type | Interventional |
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.
Status | Completed |
Enrollment | 300 |
Est. completion date | June 2006 |
Est. primary completion date | January 2006 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 19 Years and older |
Eligibility |
Inclusion Criteria: - asthma plus or minus chronic obstructive pulmonary disease (COPD) - ED visit for acute asthma treatment - age 19 years or greater Exclusion Criteria: - COPD without asthma - ED visit for asthma prescription renewal only |
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label
Country | Name | City | State |
---|---|---|---|
Canada | Chatham Kent Health Alliance | Chatham | Ontario |
Canada | St. Joseph's Healthcare | Hamilton | Ontario |
Canada | Lake of the Woods District Hospital | Kenora | Ontario |
Canada | Lakeridge Health Hospital | Oshawa | Ontario |
Canada | Grey Bruce Health Services | Owen Sound | Ontario |
Canada | Prince Edward County Hospital | Picton | Ontario |
Canada | Renfrew Victoria Hospital | Renfrew | Ontario |
Canada | Sudbury Regional Hospital | Sudbury | Ontario |
Lead Sponsor | Collaborator |
---|---|
Queen's University | Ontario Hospital Association, Ontario Ministry of Health and Long Term Care |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | % 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"). | No |
Primary | Repeat Emergency Department visit rate for asthma | Within 24, 72h, 1 month | No | |
Secondary | Hospitalization length of stay | It is not possible to specify a 'time frame'; the length of stay is the outcome | From ED presentation to hospital discharge | No |
Secondary | Length of stay in ED | From ED presentation to ED discharge | No | |
Secondary | Self-reported adherence with referral to specialized asthma services made during index ED visit | At folllowup questionnaire | No | |
Secondary | Self-reported asthma control, and use of self-management strategies (including use of action plan) | At followup questionnaire | No | |
Secondary | 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) | These are dichotomous outcomes describing actual care received during the ED visit. | During index ED visit (between ED presentation and ED discharge). | No |
Secondary | ; types of asthma medications prescribed (bronchodilators, corticosteroids) in ED and upon discharge; route of medications prescribed (IV vs oral vs. inhaled steroids; MDI vs nebulized bronchodilators) | These are dichotomous outcomes describing actual care received during the ED visit. | During index ED visit (between presentation and discharge, including discharge orders and instructions). | No |
Secondary | ; documentation of assessment and teaching of device technique | During index ED visit (between presentation and discharge, including discharge orders and instructions). | During index ED visit (between ED presentation and ED discharge) | No |
Secondary | ; documentation of asthma action plan provision or revision | During index ED visit (between ED presentation and ED discharge) | No | |
Secondary | ; type of asthma education provided (e.g. environmental trigger avoidance, warning signs, medication use) | During index ED visit (between ED presentation and ED discharge) | No | |
Secondary | ; follow-up care recommendations or referrals (AEC, Asthma Clinic, Respirology Clinic, family physician) | During index ED visit (between ED presentation and ED discharge) | No | |
Secondary | Utilization of Specialized Asthma Services | Self-reported by patient on the followup questionnaire | After discharge (within 12 months) | No |
Secondary | ; referral rates (#/year) to local AECs and Asthma Clinics | After discharge (within 12 months) | No | |
Secondary | ; types of providers involved in emergency asthma care | During index visit (between ED presentation and ED discharge) | No | |
Secondary | Proportion of patients enrolled on the ED ACP (Overall, by patient age category and by physician specialty) | During index visit (between ED presentation and ED discharge) | No | |
Secondary | Differences in patient demographics, physician demographics, day of week, time of day between patients enrolled vs. not enrolled | During index visit (between ED presentation and ED discharge) | No | |
Secondary | Perceived utility of pathway (overall, by site, and by profession) | At time of followup survey (wihtin 12 months) | No |
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