{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T17:33:50Z","timestamp":1769016830573,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,4,13]],"date-time":"2016-04-13T00:00:00Z","timestamp":1460505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008272","name":"Novartis Pharmaceuticals Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objectives were to determine whether guideline\u2010concordant emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) management of acute asthma is associated with a shorter hospital length of stay (<jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>) among patients hospitalized for asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicenter chart review study of patients aged 2\u201354 years who were hospitalized for acute asthma at one of the 25 U.S. hospitals during 2012\u20132013. Based on level A recommendations from national asthma guidelines, we derived four process measures of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> treatment before hospitalization: inhaled \u03b2\u2010agonists, inhaled anticholinergic agents, systemic corticosteroids, and lack of methylxanthines. The outcome measure was hospital <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 854 <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patients subsequently hospitalized for acute asthma, 532 patients (62%) received care perfectly concordant with the four process measures in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>. Overall, the median hospital <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content> was 2 days (interquartile range = 1\u20133 days). In the multivariable negative binomial model, patients who received perfectly concordant <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> asthma care had a significantly shorter hospital <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content> (\u221217%, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] = \u221227% to \u22125%, p = 0.006), compared to other patients. In the mediation analysis, the direct effect of guideline\u2010concordant <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> asthma care on hospital <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content> was similar to that of primary analysis (\u221216%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = \u221227% to \u22125%, p = 0.005). By contrast, the indirect effect mediated by quality of inpatient asthma care was not significant, indicating that the effect of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> asthma care on hospital <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content> was mediated through pathways other than quality of inpatient care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this multicenter observational study, patients who received perfectly concordant asthma care in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> had a shorter hospital <jats:styled-content style=\"fixed-case\">LOS<\/jats:styled-content>. Our findings encourage further adoption of guideline\u2010recommended emergency asthma care to improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12920","type":"journal-article","created":{"date-parts":[[2016,2,1]],"date-time":"2016-02-01T08:53:48Z","timestamp":1454316828000},"page":"616-622","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Association of Guideline\u2010concordant Acute Asthma Care in the Emergency Department With Shorter Hospital Length of Stay: A Multicenter Observational Study"],"prefix":"10.1111","volume":"23","author":[{"given":"Kohei","family":"Hasegawa","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barry E.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University Hospitals Case Medical Center Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard M.","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Henry Ford Hospital Detroit MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacy A.","family":"Trent","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Denver Health Medical Center Denver CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian","family":"Herrera","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals East Hanover NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals East Hanover NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane C.","family":"Bittner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Carlos A.","family":"Camargo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,4,13]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"American Lung Association.Trends in Asthma Morbidity and Mortality.2012. 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