Research Activities, May 2013
Quality measure compliance for children’s asthma care reduces hospital readmissions
Increasing provider compliance with the Joint Commission’s three quality measures for children’s inpatient asthma care by use of a standardized care process model (CPM) can significantly reduce hospital readmissions for asthma, according to a new study. Because the first two quality measures (CAC-1, percentage of patients who received beta agonists, and CAC-2, percentage of patients who received systemic steroids) were already achieved in at least 99 percent of cases in the study at baseline, only the implementation of care process changes to increase patient discharges with a home management plan of care (CAC-3) reduced 6-month asthma rehospitalizations.
The researchers analyzed data on 1,865 children hospitalized for asthma at a children’s hospital during a 6-year period—754 during preimplementation of the CPM (January 2005–December 2007), 438 during CPM implementation (January 2008–March 2009), and 673 during postimplementation (April 2009–December 2010). CAC-3 was fully implemented in 0.4 percent of cases during preimplementation, but in 86.5 percent of cases during the postimplementation phase.
The 6-month asthma readmission rates dropped from an average of 17 percent before CPM implementation to 12 percent during the postimplementation phase, but not until 9 months of sustained high compliance with CAC-3. The researchers suggest that because of existing high compliance with CAC-1 and -2 at baseline, their use as quality measures needs to be reconsidered. They used data from a large tertiary academic children’s hospital in Salt Lake City to compare outcomes before and after implementing the asthma CPM. The study was funded in part by AHRQ (HS18166 and HS18678).
More details are in "The Joint Commission Children’s Asthma Care quality measures and asthma readmissions," by Bernhard A. Fassl, M.D., Flory L. Nkoy, M.D., M.S., M.P.H., Bryan L. Stone, M.D., M.S.C.I., and others in the September 2012 Pediatrics 130(3), pp. 482-491.