You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Organisation of asthma care: what difference does it make? A systematic review of the literature.
Abstract 1:
OBJECTIVES : To evaluate the effectiveness of different forms of organisation ( delivery ) of asthma care . METHODS : A systematic review of the published evidence of effectiveness organisational methods of asthma management . Search es on computerised data bases including Medline , CINAHL , and HELMIS , and relevant citations and letters to experts were used to identify relevant studies . RESULTS : 27 studies were identified that evaluated different organisational methods of delivery across both primary and secondary sectors , such as shared care , general practice asthma clinics , outpatient programmes , inpatient admissions policies , and the use of specialists . Only one third of the studies used a r and omised controlled trial and many had small sample sizes . No conclusive evidence was found to favour any particular organisational form , although limited evidence would suggest that specialist care is better than general care and that shared care can be as effective as hospital led care . CONCLUSIONS : There is little good published research evaluating different ways of organising the delivery of asthma care . There is need for quality research on organisational methods of delivery of asthma care that could be used to inform policy makers , in particular examining whether patients treated by healthcare professional with expertise and interest in asthma will experience better outcomes


Title 2:
A cost-saving algorithm for children hospitalized for status asthmaticus.
Abstract 2:
OBJECTIVE To test the ability of an assessment -driven algorithm for treatment of pediatric status asthmaticus to reduce length and cost of hospitalization . DESIGN Nonr and omized , prospect i ve , controlled trial . SETTING Tertiary care children 's hospital . PATIENTS Children aged 1 to 18 years hospitalized for status asthmaticus ; 104 were treated using the asthma care algorithm ( intervention ) and 97 using unstructured st and ard treatment ( control ) .  INTERVENTION Patients were treated using either an assessment -based algorithm or st and ard care practice s. The algorithm group was treated with st and ard medications ( aerosolized albuterol , systemic corticosteroids , epinephrine , ipratropium ) administered at a frequency driven by the patient 's clinical condition . Specific criteria were outlined for decreasing or augmenting therapy , transferring to intensive care , and discharging to home . A unique patient record containing assessment s , algorithm cues , and a treatment record was used . Intervention group patients were interviewed by telephone 1 week after discharge . MAIN OUTCOME MEASURES Hospital length of stay , cost per hospitalization , relapse rate , protocol adherence . RESULTS Average hospital stay for intervention patients was significantly shorter than for control patients ( 2.0 vs 2.9 days , P<.001 ) . Although intervention patients received fewer aerosolized albuterol doses than controls , there was no difference in short-term relapse rate between groups . The intervention saved more than $ 700 per patient in hospital charges . Adherence to the protocol was excellent , with only 8 variances per patient stay out of more than 150 opportunities . CONCLUSION An intensive , assessment -driven algorithm for pediatric status asthmaticus significantly reduces hospital length of stay and costs without increasing morbidity


Title 3:
Change in Approach and Delivery of Medical Care in Children With Asthma: Results From a Multicenter Emergency Department Educational Asthma Management Program
Abstract 3:
OBJECTIVES . The Hawaii Child Asthma Research to Elevate St and ards ( CARES ) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program ( NAEPP ) guideline underst and ing among asthmatic children and their families , ED staff , and health care providers . METHODS . The multipronged approach used : ( 1 ) 2-phased prospect i ve tracking system of ED asthma patients ; ( 2 ) ED-based educational intervention for patients /families ; and ( 3 ) asthma education for ED staff and community-based health care providers . Data were collected across 4 EDs during phase I ( October 8 , 2002 , to October 1 , 2003 ) and phase II ( October 1 , 2003 , to July 8 , 2004 ) . Follow-up data were collected by telephone 3 weeks ( phase I ) , and 3 weeks and 3 months ( phase II ) after the ED encounter . The patient/family intervention was delivered throughout phase II . During phase I , ED and community-based health care professionals developed strategies for building an integrated asthma care system . ED staff training was delivered before phase II . Continuing medical education for health care providers was delivered before and during the first month of phase II . RESULTS . Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan . From preintervention to postintervention , the number of patients possessing a written asthma action plan increased from 48 to 322 . Of 186 persistent asthmatics , 34 were using controller medications daily , 34 as needed , and 118 not at all . Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention . CONCLUSION . An ED-based childhood asthma tracking system can serve as a basis for design ing and implementing an ED-based educational intervention . ED staff , primary care providers , and others can work together to promote asthma care


Title 4:
Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study
Abstract 4:
Aim : To determine the effect of implementing a clinical pathway , using evidence -based clinical practice guidelines , for the emergency care of children and adolescents with asthma . Methods : A prospect i ve , before – after , controlled trial was conducted , which included patients aged 1–18 years who had acute exacerbations of asthma treated in a tertiary care paediatric emergency department . Data were collected for identical 2-month seasonal periods before and after implementation of the clinical pathway to determine hospitalisation rate and other outcomes . For 2 weeks after emergency visits , the rate at which patients returned to emergency care for worsening asthma was evaluated . A multidisciplinary panel , using national guidelines and a systematic review , developed the pathway . Results : 267 patients were studied .  The rate of hospitalisation was significantly lower in the post-implementation group ( 10/74 ; 13.5 % ) than in the pre-implementation control group ( 53/193 ; 27.5 % ; p = 0.02 ; number needed to treat 7.1 ) . All reduction in hospitalisation occurred in children with moderate to severe asthma exacerbation . After implementation of the clinical pathway , the rate of administration of oral corticosteroids to patients with moderate or severe exacerbations increased from 71 % to 92 % ( p = 0.01 ) , and significantly more patients received β2-agonists in the first hour ( p = 0.02 ) . No significant change in relapse to acute care occurred within 2 weeks ( p = 0.19 ) . Conclusions : An evidence -based clinical pathway for children and adolescents with moderate to severe exacerbations of acute asthma markedly decreases their rate of hospitalisation without increased return to emergency care


Title 5:
Improved outcomes for hospitalized asthmatic children using a clinical pathway.
Abstract 5:
BACKGROUND Although asthma clinical pathways are used with increasing frequency , few controlled studies have evaluated the clinical and cost effectiveness of these pathways . OBJECTIVE To evaluate the effect of an inpatient asthma clinical pathway on cost and quality of care for children with asthma . METHODS One hundred forty-nine children were treated for status asthmaticus using an asthma clinical pathway in a children 's hospital between September and December 1997 . Thirty-four of 149 children treated with the clinical pathway were r and omly selected . A retrospective cohort control group of  non-pathway patients ( N = 34 ) was matched with each pathway patient by age , race , gender , co-morbidities , asthma severity score , ICU admission , and time of year admitted . Differences between the two groups in length of stay , total costs , readmission rate , inpatient management , and discharge medications were compared . RESULTS Length of stay was significantly lower in the clinical pathway group compared with the control group ( 36 hours versus 71 hours , P < .001 ) and total costs decreased significantly ( $ 1685 versus $ 2829 , P < .001 ) as a result of the pathway . Asthmatic children on the clinical pathway were significantly more likely than the control group to complete asthma teaching while hospitalized ( 65 % versus 18 % , P < .001 ) , to be discharged with a prescription for a controller medication ( 88 % versus 53 % , P < .01 ) , and to have a peak flow meter ( 57 % versus 23 % , P < .05 ) and a spacer device ( 100 % versus 71 % , P < .001 ) for home use . CONCLUSION Implementation of this inpatient clinical pathway led to a decrease in length of stay and a reduction in total cost while improving quality of care for hospitalized asthmatic children


Title 6:
Effectiveness of a Clinical Pathway for Inpatient Asthma Management
Abstract 6:
Background . Clinical pathways for asthma are tools that have the potential to improve compliance with nationally recognized management guidelines , but their effect on patient outcomes has not been documented . Objectives . To determine the effect of an asthma clinical pathway on  patients ' length of stay , use of nebulized β-agonist therapy while hospitalized , and use of acute care clinics for 2 weeks after discharge . Design / Methods . The study was a r and omized , controlled trial . Patients between the ages of 2 and 18 years admitted with an asthma exacerbation and not under the care of an asthma specialist were eligible for the study . Patients were r and omized either to a conventional ward ( control group ) or to a ward using the clinical pathway ( intervention group ) . For 2 weeks after discharge , we collected data to determine whether patients visited a health care provider for worsening asthma . Results . One hundred ten patients ( 26 % ) were enrolled . Control and intervention groups had similar demographic and asthma severity profiles . The intervention group had an average length of stay 13 hours shorter than did the control group . In addition , at every dosing interval , the intervention group received less nebulized β-agonist therapy . There were no deaths in either group . Conclusion . A clinical pathway for inpatient asthma decreased the length of stay and β-agonist medication use with no adverse outcomes or increased acute-care encounters through 2 weeks after discharge


Title 7:
Effect of an integrated care pathway on acute asthma/wheeze in children attending hospital: cluster randomized trial.
Abstract 7:
OBJECTIVE To determine whether an integrated care pathway ( ICP ) could improve care delivered to patients coming to an emergency department only or to patients who were subsequently admitted . STUDY DESIGN Children ( age , 2 - 16 years ; n = 298 ) coming to the ED with acute asthma/wheeze , were r and omized by using a cluster design to either st and ard care or care delivered by an ICP . RESULTS Children discharged from the ED who received care with an ICP ( n = 118 ) received more  prednisolone  ( 81 % ; st and ard , 63 % ; P = .03 ) and increased advice to obtain primary care review  ( 72 % ; st and ard , 33 % ; P < .0001 ) . A total of 180 children were admitted ( 94 ICP , 86 st and ard ) . The rate of recovery was unchanged by ICP . The mean ICP length of stay ( 37.6 hours ; range , 33.5 - 42.4 hours ) , was 93 % of the mean st and ard length of care ( 40.7 hours ; range , 35.9 - 46 ; P = .36 ) . When a discharge checklist was completed ( 60 of 94 cases ) , the mean ICP length of stay was 34.2 hours ( range , 30.5 - 38.4 hours ; P = .07 versus st and ard ) . An ICP result ed in a 30 % reduction in prescribing errors ( mean , 10.4 ; st and ard , 14.8 ; P = .002 ) . Eighty-four of 94 children with an ICP received a 48-hour discharge plan ( 89 % ) versus 35 of 86 children with st and ard care ( 41 % ) . More clinical contacts were observed in children receiving care by an ICP ( mean , 22 , versus st and ard , 19.2 : P = .0004 ) . CONCLUSION An acute asthma/wheeze ICP improved education and prescribing errors , modestly reduced the length of stay when discharge criteria were adhered to , but did not influence recovery time . Further consideration of the effect on staff workload is required
Using asthma CPs may decrease the length of hospital stay ; however , CPs did not appear to reduce additional visits due to asthma exacerbations or reduce hospital costs .
Current studies suggest CPs may reduce the length of hospital stay , but insufficient evidence is available on total costs or readmissions to justify extensive uptake of asthma CPs in paediatric inpatient care .