# The SHAKE Study: Sustaining High-quality Asthma care for Kids Everywhere

> **NIH AHRQ R03** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $52,722

## Abstract

PROJECT SUMMARY/ABSTRACT
Healthcare providers' face many challenges adhering to evidence-based guidelines, and this contributes to poor
health outcomes for the >100,000 children hospitalized with asthma annually in the United States. Successful
methods to promote providers' initial adoption of guidelines have been developed, but to date, little research has
focused on methods to robustly sustain guideline adherence. Adherence commonly deteriorates after initial
implementation resources are removed. This adversely impacts children with asthma, as >70% are cared for in
general hospitals, where resources tend to be preferentially allocated to adult care. Pathways (succinct versions
of guidelines that provide visual, step-by-step guidance for healthcare providers) improve quality of care for
children hospitalized with asthma. Pathway implementation strategies (methods for promoting pathway
implementation) have achieved short-term improvements in care of children in general hospitals. However, to
reap maximum value from limited implementation resources, we must identify asthma pathway implementation
strategies that promote sustained delivery of high-quality care for children in general hospitals. To achieve that
objective, this proposal harnesses the “positive deviance” approach, which asserts that identification and
examination of higher- and lower-performing hospitals can facilitate the discovery and wide dissemination of
strategies to improve care. Specific aim 1 will involve a secondary quantitative analysis of existing data. Multi-
level regression models with an interrupted-time series approach will be used to identify hospital-level factors
associated with sustainability and hospitals with higher and lower sustainability performance. Sustainability will
be defined as maintenance of higher guideline adherence and higher quality of care at 2 years after pathway
implementation (long-term benefit) without declines after implementation resources are removed. Outcomes will
include length of stay (clinical outcome that reflects time to recovery) and use of metered-dose inhalers (guideline
adherence). Specific aim 2 will study the higher- and lower-performing general hospitals identified in Aim 1 using
qualitative, constant comparative methods. The ERIC Framework of implementation strategies will be used to
develop a semi-structured interview guide for key personnel involved in pathway implementation. This analysis
will identify pathway implementation strategies that promote sustainability and important contextual factors that
influence their success. This mixed-methods approach will produce a multi-dimensional, comprehensive
understanding of how general hospitals can promote sustained delivery of high-quality care for children with
asthma. These findings will fill crucial gaps in our understanding of sustainability, enable general hospitals to
more effectively target limited resources, and enable us to develop a comparative-effectiveness trial of
sust...

## Key facts

- **NIH application ID:** 10118174
- **Project number:** 5R03HS027041-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Sunitha Vemula Kaiser
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $52,722
- **Award type:** 5
- **Project period:** 2020-04-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10118174

## Citation

> US National Institutes of Health, RePORTER application 10118174, The SHAKE Study: Sustaining High-quality Asthma care for Kids Everywhere (5R03HS027041-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10118174. Licensed CC0.

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