Quality Improvement in Pediatric Asthma: A Systematic Review
Creators: name: Webb, Alexi-rae
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2018

description: Background and Significance: Asthma remains one of the most prevalent chronic diseases affecting the pediatric population.  The burden of disease asthma poses to children in the United States serves as evidence of its far-reaching life-altering potential: the CDC estimates that, in 2013, 6,109,000, or 8.3% of all US children under age 18, were diagnosed with asthma.  However, it is clear from the data that wide gaps exist in current management practices among pediatricians, despite the fact that best practice guidelines are in place.  Quality improvement processes stand to change the face of this variation, but not before we understand which parts of the QI process are effective, and which are unhelpful.Purpose: The purpose of this systematic review is to conduct a methodological review of the literature to better understand the following questions: What types of quality improvement initiatives are clinicians who provide care for the pediatric asthma population currently undertaking?  What variables determine which quality improvement initiatives are successfully implemented, and what effect does this implementation have on health outcomes?Methods: Data were abstracted and extracted using a critical appraisal table by an individual reviewer.  No meta-analyses were performed.  Summary measures included p-values and odds ratios with confidence intervals. Results: Thirteen articles were retrieved from PubMed.  Three met the pre-defined inclusion and exclusion criteria and were included in this systematic review.  Overall, quality improvement initiatives that aim to address current management practices of pediatric patients with asthma tend to have large, positive influences on outcomes.  The challenges providers face oftentimes are in the form of deciding which variables the initiative should address, in generating buy-in from key stakeholders, and, closely related to generating buy-in, finding ways to incorporate concerns identified by key stakeholders in the developmental stages of the quality improvement process.  A key variable determining the success of implementation is the degree to which leaders of the quality improvement initiative are able to gain key stakeholder interest, and, by the same token, the level to which the initiative is able to address parts of the care process that key stakeholders identify as important.  Discussion: The evidence from this systematic review both highlights that the implementation of quality improvement initiatives can be done successfully, and that, when done successfully, can have a considerably large effect on the health outcomes of members of the pediatric asthmatic population.  What is more, it demonstrates key variables that help define or predict whether the initiative may be a success or failure.  Paying attention to the opinions and perspectives of staff members appears to be an important characteristic of an implementation process that will likely be successful, as is implementing components of the quality improvement initiative in phases.  Of all that the evidence suggests, perhaps the most important is the breadth of effect quality improvement initiatives can have.  We have more work to do, however.Limitations: The main limitation, however, is the fact that only three eligible studies were identified.