Evaluation of the implementation of evidence-based pediatric asthma exacerbation treatments in a regional consortium of emergency medical Services Agencies

Asthma exacerbations are a frequent reason for pediatric emergency medical services (EMS) encounters. The objective of this study was to examine the implementation of evidence-based treatments for pediatric asthma in a regional consortium of EMS agencies. This retrospective study applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework to data from an EMS agency consortium in the Cincinnati, Ohio region. The study analyzed one year before an oral systemic corticosteroid (OCS) option was added to the agencies’ protocol, and five years after the protocol change. We constructed logistic regression models for the primary outcome of <i>Reach</i>, defined as the proportion of pediatric asthma patients who received a systemic corticosteroid. We modeled <i>Maintenance</i> (<i>Reach</i> measured monthly over time) using time series models. A total of 713 patients were included, 133 pre- and 580 post-protocol change. In terms of <i>Reach</i>, 3% (<i>n</i> = 4) of eligible patients received a systemic corticosteroid pre-OCS versus 20% (<i>n</i> = 116) post-OCS. Multivariable modeling of <i>Reach</i> revealed the study period, EMS transport time, months since implementation of OCS, and number of bronchodilators administered by EMS as significant covariates for the administration of a systemic corticosteroid. For <i>Maintenance,</i> it took approximately two years to reach maximal administration of systemic corticosteroids. Indicators of asthma severity and time since the protocol change were significantly associated with EMS administration of systemic corticosteroids to pediatric asthma patients. The two-year time for maximal <i>Reach</i> suggests further work is required to understand how to best implement evidence-based pediatric asthma treatments in EMS.

哮喘急性加重是儿科急诊医疗服务（Emergency Medical Services，EMS）接诊的常见原因。本研究旨在考察美国俄亥俄州辛辛那提地区急诊医疗服务机构联盟内，儿科哮喘循证治疗的实施现状。本项回顾性研究采用覆盖度（Reach）、有效性（Effectiveness）、采用度（Adoption）、实施性（Implementation）与维持性（Maintenance）构成的RE-AIM实施框架，对该区域急诊医疗服务机构联盟的数据展开分析。研究分析了口服全身性糖皮质激素（oral systemic corticosteroid, OCS）被纳入机构诊疗方案前1年，以及方案变更后5年的相关数据。本研究以覆盖度（Reach）作为主要结局指标——其定义为接受全身性糖皮质激素治疗的儿科哮喘患者占比——构建了logistic回归模型。针对维持性（Maintenance，即随时间按月统计的覆盖度），本研究采用时间序列模型进行建模。本研究共纳入713例患者，其中方案变更前133例，变更后580例。就覆盖度（Reach）而言，OCS方案实施前，符合纳入标准的患者中仅3%（n=4）接受了全身性糖皮质激素治疗；而方案实施后，这一比例升至20%（n=116）。覆盖度（Reach）的多变量回归分析显示，研究阶段、EMS转运时长、OCS实施后的月份数，以及急诊医疗服务人员给予的支气管扩张剂使用剂量，均为影响全身性糖皮质激素给药的显著协变量。关于维持性（Maintenance），全身性糖皮质激素的给药率达到峰值约需两年时间。哮喘严重程度指标与方案变更后的时长，均与急诊医疗服务机构对儿科哮喘患者给予全身性糖皮质激素治疗显著相关。达到最优覆盖度需两年时间，这提示未来仍需开展进一步研究，以明确如何在急诊医疗服务场景中最优地推行儿科哮喘循证治疗方案。