PURPOSE OF THE STUDY.
To examine provider compliance with 3 Joint Commission Children’s Asthma Care (CAC) measures, β-agonist use (CAC 1), systemic steroid use (CAC 2), and patient discharge with a home management plan of care (CAC 3). The study also examined whether use of these measures had an impact on the rate of patient readmission to the hospital for asthma care. Additional measures examined included length of stay, costs, and relative resource units.
A total of 1865 patients, ages 2 to 17 years, discharged between January 1, 2005, and December 31, 2010, from the Primary Children’s Medical Center in Salt Lake City, Utah, with the primary diagnosis code for asthma (493.xx).
An asthma care process model was designed, based on national guidelines and asthma quality measures. Initial implementation was facilitated by paper-based decision support tools such as admission and discharge order sets. Due to difficulties with consistency in documentation, an electronic discharge order set was implemented. All information was determined from retrospective chart review. Provider adherence with all 3 measures was documented. Rate of readmission to any of 22 surrounding hospitals or emergency departments for each patient was noted.
Preimplementation with CAC 1 and CAC 2 were high at 99% and 100%, respectively. Preimplementation compliance with CAC 3 was 0% but improved to 87% during postimplementation period. After 9 months, readmission rates decreased from 17% to 12%. No statistically significant differences were observed for any of the secondary hospitalization outcomes.
Implementation of an asthma care process model compliant with CAC measures is associated with a sustained, though delayed, reduction in asthma readmissions with no changes in secondary hospitalization outcomes, such as length of stay or cost of hospitalization. High baseline compliance with CAC 1 and CAC 2 suggests that they may not be ideal measures in evaluating effective care for childhood asthma.
An inpatient asthma care model, including an asthma action plan at discharge, reduces hospital readmissions. Though the specific care models may differ between hospitals and providers, the importance of time spent educating patients and their families about appropriate pharmacotherapy and environmental control of asthma cannot be understated. Although this facility demonstrated high baseline compliance with β-agonist and oral steroid use, this should not undermine the importance of these measures in asthma care. This study serves as a reminder to health care providers of the significant role that patient education plays in the long-term care of children with asthma.
- Copyright © 2013 by the American Academy of Pediatrics