Purpose: To evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia.
Methods: A cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services.
Results: A total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81– 96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4– 91.3) and between EDs and paediatric wards (p=9.4× 10^{− 9}); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2– 3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up.
Conclusion: There are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.

Keywords: asthma, children, post-hospitalization, community-based, integrated care


中文翻译：

---

急性哮喘患儿出院后护理变化的评估

目的：评估澳大利亚新南威尔士州哮喘儿童出院后护理管理途径的潜在变化。
方法：2018 年 7 月至 2019 年 3 月期间，在澳大利亚新南威尔士州拥有 5 张以上儿科床位的公立医院急诊科 (ED) 和儿科病房进行了一项基于网络的横断面调查。急诊科和儿科的护理人员和医务人员邀请在过去 12 个月内曾照顾过 18 岁以下哮喘儿童的单位参与本研究。结果测量包括使用临床实践指南和哮喘行动计划（AAP）；出院后随访建议；为父母/照顾者提供哮喘教育；社区哮喘服务的可用性；与学校/托儿服务机构的沟通。
结果：共纳入来自 37 家医院的 502 名参与者（236 名护理人员和 266 名医务人员，回复率=22%）。总体而言，AAP 的使用并不普遍（中位数=90%；IQR=81-96%），不同地方卫生区（LHD）（88.6%，95% CI=85.4-91.3）以及急诊科和儿科病房之间存在显着差异( p =9.4× 10 ^{- 9}); 并使用了一系列哮喘临床实践指南。70% 的受访者建议在出院后 2-3 天内进行随访，但只有 8% 的受访者表示医院有确保随访合规性的系统。在住院期间很少向父母/照顾者提供正式的哮喘教育课程（27% 的受访者），尤其是在急诊室（14% 的受访者）。不到 50% 的受访者知道任何针对儿童的哮喘社区服务，只有 4% 的受访者报告说学校/托儿服务机构被告知孩子因哮喘发作而入院。
结论：新南威尔士州儿童的出院后哮喘护理和社区管理存在显着差异。一个综合的标准化护理模型可以改善哮喘儿童的健康状况。

关键词：哮喘，儿童，出院后，以社区为基础，综合护理