Evaluating Inpatient Asthma Management Practices in Florida Hospitals

We evaluated inpatient asthma management practices in 10 Florida hospitals. We wanted to learn about care protocols, instrumental resources, and use of evidence-based guidelines. We sought to recommend strategies for improving care based on gaps identified by this study. We developed a survey that included detailed questions on care strategies and resources. Guidelines from the National Heart, Lung, and Blood Institute (NHLBI) in the Expert Panel Report 3 (EPR-3) for the Diagnosis and Management of Asthma were a primary focus. Hospitals were given the option of completing their surveys by phone or email. Data were analyzed via content coding of completed surveys. Most participating hospitals had robust protocols and resources in place for inpatient asthma management, and continually reassessed these resources for quality improvement. Overall, inpatient care practices at these hospitals adhered strongly to national guidelines for asthma management. Inpatient asthma care practices at surveyed Florida hospitals are largely robust, evidence-based, and constantly improving. Our findings suggest not only that hospitals in Florida are deeply committed to effective asthma management, but also that they have active interest in collaborating with one another to further improve care. Florida Public Health Review, 2015; 12, 13-22. BACKGROUND Direct and indirect costs related to asthma in the United States totaled approximately $56 billion annually from 2002 to 2007 (Dudley, 2012; Barnett & Nurmagambetov, 2011). Yet, asthma prevalence and care costs continue to rise in many states, including Florida (Dudley, 2012). Asthma exerts major impacts on health-related quality of life (Adams et al., 2001), which also contributes to the societal costs of asthma. Investment in preventive care may reduce these costs (Grumbach & Grundy, 2010). Yet, despite efforts to improve primary care, asthma prevalence and costs continue to rise in many states, including Florida (Dudley, 2012). These factors suggest that improving asthma management is crucial for Florida and other states. Many inpatient hospital stays can be avoided with proper asthma management (Lieu et al., 1997). Yet, in 2010, a total of 30,910 inpatient hospitalizations occurred in Florida with asthma listed as the primary diagnosis; an increase of 8.1% since 2005 (Dudley, 2012). The total annual charges associated with these visits increased by more than half between 2005 and 2010, rising to $748.5 million. A collaborative team from Florida thus developed an evaluation project to increase knowledge of current practices and illuminate gaps in preventive strategies. In spring 2012, the Florida Asthma Program (FAP) at the Florida Department of Health collaborated with evaluators from the Florida State University College of Medicine (FSU), the Florida Asthma Coalition (FAC), and professionals from the Florida Hospital Association (FHA) to assess asthma management practices in select Florida hospitals. The team developed a qualitative survey that explored quality assurance efforts and performance improvement initiatives within inpatient units. This instrument focused on compliance with the National Heart, Lung, and Blood Institute’s Expert Panel Report 3, Guidelines on the Diagnosis and Management of Asthma (EPR-3 guidelines). We concluded our study by developing recommendations for further improvement of inpatient asthma management. These recommendations have since informed collaborative efforts to enhance asthma management within and around Florida hospitals. Specific strategies thus far have included developing interactive webinars for hospital professionals and