IMPROVING THE MANAGEMENT OF ACUTE ASTHMA IN CHILDREN THROUGH AN INTEGRATED CARE PATHWAY: AN IMPLEMENTATION STUDY PROTOCOL

Marta Montejo^1,2Natalia Paniagua^2,3Alvaro Sanchez^2,4,5*Mikel Rueda-Etxebarria²Jose Ignacio Pijoan^2,6,7Carlos Saiz Hernando⁸Vanesa Martin⁹Miguel Angel Vázquez Ronco¹⁰Mikel Santiago Burruchaga¹¹Diego García Urabayen¹²Garbiñe Pérez Llarena³Susana Castelo¹³Javier Benito^2,3

• ¹San Vicente Health Centre, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
• ²Biobizkaia Health Research Institute, Barakaldo, Spain
• ³Pediatric Emergency Department, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
• ⁴Primary Care Research Unit of Bizkaia, Deputy Directorate of Healthcare Assistance, Osakidetza-Basque Health Service, Barakaldo, Spain
• ⁵Network for Research on Chronicity, Primary Care, and Health Promotion (RICCAPS), Barakaldo, Spain
• ⁶Clinical Epidemiology Unit, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
• ⁷CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
• ⁸Department of Medical Documentation, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
• ⁹Quality and Innovation Unit, Barakaldo-Sestao Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
• ¹⁰Pediatric Hospitalization, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
• ¹¹Pediatric Pulmonology and Cystic Fibrosis Unit, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Barakaldo, Spain
• ¹²Pediatric Intensive Care Unit, Cruces University Hospital, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain
• ¹³Innovation Unit, Ezkerraldea-Enkarterri-Cruces Integrated Health Organization, Osakidetza-Basque Health Service, Barakaldo, Spain

Introduction: This study aims to evaluate the effectiveness and feasibility of the implementation of an Asthma Integrated Care Pathway (AICP) to improve care and reduce variability according to recommended clinical practice guidelines, for children presenting with acute asthma episodes in paediatric primary care, and hospital services including emergency departments.Methods and analysis: A cluster quasi-experimental implementation trial with a matched control group will be launched in a regional healthcare service. All the paediatric healthcare professionals providing care in two health districts (HDs) will receive interventions over two 12-month periods during which components of the implementation strategy to favour adoption of the AICP will be deployed cumulatively. A selected set of professionals from the same levels of care in the other HDs (N=11) will serve as the comparison group. The target population of the AICP is children between 2 and 14 years old presenting with an acute asthma episode during the study period. A mixed methods evaluation guided by the RE-AIM framework will assess the effectiveness of the AICP after 12, 24, and 36 months in a set of pre-specified care and implementation outcomes at the professional level. The perceived feasibility of the AICP and its implementation from the perspective of physicians and the experience and satisfaction of patients concerning the clinical care received will be assessed through discussion groups.Discussion: This study performed in real-world settings will contribute in extending knowledge in asthma care pathways beyond emergency settings into primary care and across the healthcare continuum. In addition, its findings aim to guide health systems in reducing variability in care, increasing guideline adherence, and ultimately improving paediatric asthma outcomes across the system. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT06437444.