PURPOSE OF THE STUDY.
To evaluate longitudinal trends in compliance with the Joint Commission Children’s Asthma Care (CAC) process measure set and to determine possible associations between CAC compliance and outcomes.
Sample of randomly selected pediatric inpatients (aged 2–17 years) with a principal discharge diagnosis of asthma.
Administrative and CAC compliance data from 30 US hospitals were reviewed. A standardized data collection tool measured the following: (1) if children received relievers (CAC-1); (2) if they received systemic corticosteroids (CAC-2); or (3) if they were discharged with an individualized home management care plan (HPMC) (CAC-3) and subcomponent measures. Outcome measures were postdischarge emergency department (ED) utilization and asthma-related readmission rates at 7, 30, and 90 days.
A total of 37 267 children with 45 499 asthma hospital admissions were included. The compliance rates reported for CAC-1 and CAC-2 were high (>90%); hence, association with outcomes was not analyzed. There was interhospital and temporal variation for CAC-3 compliance (best mean value: 72.9%). Mean postdischarge ED utilization rates and quarterly readmission rates ranged from 1.5% to 11.1% and 1.4% to 7.6% at 7 and 90 days, respectively. There was no significant association between CAC-3 compliance and any of the outcome measures.
Compliance with CAC-1 and CAC-2 measures in pediatric hospitals was high. The lower compliance with the CAC-3 measure was not linked to ensuing ED visits and readmissions.
The findings of this study are reassuring in that use of bronchodilators and systemic steroids in patients hospitalized for asthma is standard of care. The CAC-3 measure, in its current form, indicates that an HPMC document was completed and given to the patient. However, the quality and methods of executing the interventions postdischarge in the HPMC were not evaluated. The outcome measure may be inappropriate in its expectation that high-quality discharge leads to a decrease in ED/hospital “bounce-backs.” Therefore, pending an established link between CAC-3 compliance and improved outcomes, the Joint Commission should reassess the use of the CAC-3 component as an “accountability measure” appropriate for public reporting, accreditation, or pay for performance.
- Copyright © 2012 by the American Academy of Pediatrics