Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), HEALTH_CARE_PROVIDER_PRACTICE, Active Management of Labor, Midwifery

Intervention Description: To explore the relationship between the degree to which labour is established on admission to hospital and method of birth.

Intervention Results: Nulliparous women randomised to standard care were more likely to have labour augmented than those having caseload care (54.2% and 45.5% respectively, p=0.008), but were no more likely to use epidural analgesia. They were admitted earlier in labour, spending 1.1 hours longer than those in the caseload arm in hospital before the birth (p=0.003). Parous women allocated to standard care were more likely than those in the caseload arm to use epidural analgesia (10.0% and 5.3% respectively, p=0.047), but were no more likely to have labour augmented. They were also admitted earlier in labour, with a median cervical dilatation of 4 cm compared with 5 cm in the caseload arm (p=0.012). Pooling the two randomised groups of nulliparous women, and after adjusting for randomised group, maternal age and maternal body mass index, early admission to hospital was strongly associated with caesarean section. Admission before the cervix was 5 cm dilated increased the odds 2.4-fold (95%CI 1.4, 4.0; p=0.001). Augmentation of labour and use of epidural analgesia were each strongly associated with caesarean section (adjusted odds ratios 3.10 (95%CI 2.1, 4.5) and 5.77 (95%CI 4.0, 8.4) respectively.

Conclusion: These findings that women allocated to caseload care were admitted to hospital later in labour, and that earlier admission was strongly associated with birth by caesarean section, suggest that remaining at home somewhat longer in labour may be one of the mechanisms by which caseload care was effective in reducing caesarean section in the COSMOS trial.

Study Design: RCT

Setting: 1 large, tertiary maternity hospital

Population of Focus: Nulliparous women with a planned vaginal delivery who gave birth after recruitment between September 2007 and June 20102

Data Source: Not specified

Sample Size: n=1,532

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): , Care Coordination, Case Management

Intervention Description: The intervention was a coordinated asthma discharge bundle that included several components, such as tailored bedside education, enrollment in a community asthma prevention program (CAPP), facilitated discharge medication filling, and expedited specialty follow-up. The tailored bedside education included a review of the patient's asthma action plan, medication regimen, and inhaler technique. The CAPP enrollment involved a referral to a community-based program that provided asthma education, home visits, and environmental assessments. The facilitated discharge medication filling involved ensuring that patients had their medications filled before leaving the hospital. The expedited specialty follow-up involved scheduling a follow-up appointment with an allergy or pulmonology specialist within 30 days of discharge. The intervention was implemented from May 2016 to April 2017, and the study used statistical process control charts and difference-in-differences analysis to estimate the impact of the intervention on monthly 30-day revisits to the ED or hospital.

Intervention Results: From May 1, 2016, to April 30, 2017, we enrolled 79 patients in the intervention, and 128 patients constituted the control group. Among the eligible population, the average monthly proportion of children experiencing a revisit to the ED and hospital within 30 days declined by 38%, from a historical baseline of 24% to 15%. Difference-in-differences analysis demonstrated 11.0 fewer 30-day revisits per 100 patients per month among intervention recipients relative to controls (95% confidence interval: -20.2 to -1.8; P = .02).

Conclusion: Yes, the study found statistically significant reductions in the monthly proportion of children experiencing a revisit to the ED or hospital within 30 days of a qualifying hospitalization. The average monthly proportion of children experiencing a revisit declined by 38%, from a historical baseline of 24% to 15%. The difference-in-differences analysis demonstrated 11.0 fewer 30-day revisits per 100 patients per month among intervention recipients relative to controls (95% CI: (−20.2, −1.8); p=0.02). The study also found significant improvements in the completion of various components of the asthma discharge bundle, including inpatient risk screener completion, tailored education, CAPP referral, facilitated discharge medication filling, and expedited specialty follow-up.

Study Design: The study design was a longitudinal quality improvement (QI) initiative supplemented with an assessment of robustness using difference-in-differences analysis. The study aimed to evaluate the effectiveness of a coordinated asthma discharge bundle in reducing repeat emergency department (ED) and inpatient care for patients with frequent asthma-related hospitalizations. The intervention was implemented from May 2016 to April 2017, and the study used statistical process control charts and difference-in-differences analysis to estimate the impact of the intervention on monthly 30-day revisits to the ED or hospital.

Setting: The study was conducted at a large, academic children's hospital in the United States. The target cohort for the study consisted of children who were admitted to the inpatient setting for asthma at this hospital. Additionally, the primary care for the eligible children was provided at three inner-city primary care centers affiliated with the hospital.

Population of Focus: The target audience for the study includes healthcare professionals, pediatricians, pulmonologists, allergists, hospital administrators, and policymakers involved in pediatric asthma care and population health management. Additionally, researchers and professionals interested in quality improvement initiatives and interventions aimed at reducing healthcare utilization for children with asthma may also find the study relevant.

Sample Size: The study sample consisted of 207 children between the ages of 2 and 17 who had been hospitalized for asthma exacerbations three or more times within the previous year. Of these, 79 children were enrolled in the intervention group, and 128 children were in the control group.

Age Range: The age group for this initiative was children ages 2-17 who were hospitalized for asthma at least three times in the prior year.