Improving Quality of Acute Asthma Care in U.S. Hospitals: Changes between 1999-2000 and 2012-2013.

Little is known about the longitudinal change in quality of acute asthma care for hospitalized children and adults in the U.S. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length-of-stay (LOS).Analysis of data from two multicenter chart review studies of hospitalized patients aged 2-54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient- and hospital-levels, and association of patient composite concordance with hospital LOS.Analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 versus 800 patients from 2012-2013. Over these ∼15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P<.001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared to Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (-14%; 95%CI, -23% to -4%; P=.009).Between 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, inter-hospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS.