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American Academy of Pediatrics
Article

The Joint Commission Children’s Asthma Care Quality Measures and Asthma Readmissions

Bernhard A. Fassl, Flory L. Nkoy, Bryan L. Stone, Rajendu Srivastava, Tamara D. Simon, Derek A. Uchida, Karmella Koopmeiners, Tom Greene, Lawrence J. Cook and Christopher G. Maloney
Pediatrics September 2012, 130 (3) 482-491; DOI: https://doi.org/10.1542/peds.2011-3318
Bernhard A. Fassl
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Flory L. Nkoy
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Bryan L. Stone
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Rajendu Srivastava
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Tamara D. Simon
bDepartment of Pediatrics, University of Washington, Seattle, Washington; and
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Derek A. Uchida
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Karmella Koopmeiners
bDepartment of Pediatrics, University of Washington, Seattle, Washington; and
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Tom Greene
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Lawrence J. Cook
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Christopher G. Maloney
aDepartment of Pediatrics, University of Utah, Salt Lake City, Utah;
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Abstract

BACKGROUND AND OBJECTIVES: The Joint Commission introduced 3 Children’s Asthma Care (CAC 1–3) measures to improve the quality of pediatric inpatient asthma care. Validity of the commission’s measures has not yet been demonstrated. The objectives of this quality improvement study were to examine changes in provider compliance with CAC 1–3 and associated asthma hospitalization outcomes after full implementation of an asthma care process model (CPM).

METHODS: The study included children aged 2 to 17 years who were admitted to a tertiary care children’s hospital for acute asthma between January 1, 2005, and December 31, 2010. The study was divided into 3 periods: preimplementation (January 1, 2005–December 31, 2007), implementation (January 1, 2008–March 31, 2009), and postimplementation (April 1, 2009–December 31, 2010) periods. Changes in provider compliance with CAC 1–3 and associated changes in hospitalization outcomes (length of stay, costs, PICU transfer, deaths, and asthma readmissions within 6 months) were measured. Logistic regression was used to control for age, gender, race, insurance type, and time.

RESULTS: A total of 1865 children were included. Compliance with quality measures before and after the CPM implementation was as follows: 99% versus 100%, CAC-1; 100% versus 100%, CAC-2; and 0% versus 87%, CAC-3 (P < .01). Increased compliance with CAC-3 was associated with a sustained decrease in readmissions from an average of 17% to 12% (P = .01) postimplementation. No change in other outcomes was observed.

CONCLUSIONS: Implementation of the asthma CPM was associated with improved compliance with CAC-3 and with a delayed, yet significant and sustained decrease in hospital asthma readmission rates, validating CAC-3 as a quality measure. Due to high baseline compliance, CAC-1 and CAC-2 are of questionable value as quality measures.

KEY WORDS
  • asthma
  • compliance
  • hospitalization
  • quality improvement
  • quality of care
  • Abbreviations:
    CAC —
    Children’s Asthma Care
    CPM —
    Care Process Model
    EDOS —
    electronic discharge order set
    ED —
    emergency department
    EDW —
    enterprise data warehouse
    HMPC —
    home management plan of care
    LOS —
    length of stay
    PCMC —
    Primary Children’s Medical Center
    QI —
    quality improvement
    RRU —
    relative resource unit
    TJC —
    The Joint Commission
    • Accepted April 27, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 3
    1 Sep 2012
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    The Joint Commission Children’s Asthma Care Quality Measures and Asthma Readmissions
    Bernhard A. Fassl, Flory L. Nkoy, Bryan L. Stone, Rajendu Srivastava, Tamara D. Simon, Derek A. Uchida, Karmella Koopmeiners, Tom Greene, Lawrence J. Cook, Christopher G. Maloney
    Pediatrics Sep 2012, 130 (3) 482-491; DOI: 10.1542/peds.2011-3318

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    The Joint Commission Children’s Asthma Care Quality Measures and Asthma Readmissions
    Bernhard A. Fassl, Flory L. Nkoy, Bryan L. Stone, Rajendu Srivastava, Tamara D. Simon, Derek A. Uchida, Karmella Koopmeiners, Tom Greene, Lawrence J. Cook, Christopher G. Maloney
    Pediatrics Sep 2012, 130 (3) 482-491; DOI: 10.1542/peds.2011-3318
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