Improving Home Management Plan of Care Compliance Rates Through an Electronic Asthma Action Plan. (August 2013)

• Record Type: Journal Article
• Authors: Zipkin, Ronen; Schrager, Sheree M.; Keefer, Matthew; Marshall, Lori; Wu, Susan
• Is Part Of: Journal of asthma. Volume 50:Number 6(2013)
• Page Start: 664
• Page End: 671
• Publication Date: 2013-08
• Subjects: children's asthma care -- Joint Commission; Asthma -- Periodicals; 616.238005
• DOI: 10.3109/02770903.2013.793708
• Languages: English
• ISSNs: 0277-0903

Abstract

Abstract : Background. In 2007, the Joint Commission mandated reporting of three children's asthma care (CAC) measures for hospitalized patients with asthma. The third children's asthma care measure (CAC-3) focuses on hospital discharge with a comprehensive home management plan of care (HMPC) based on the clinical severity. Objective. To improve CAC-3 compliance and identify what interventions would have the most impact. Methods. This was a retrospective observational study, conducted at the Children's Hospital Los Angeles (CHLA) between October 2008 and January 2012. A total of 470 patients admitted with a primary diagnosis of asthma were included. Four Plan-Do-Study-Act cycles testing separate interventions were used throughout the study period: clinical care coordinators (CCCs), red clipboard for paper HMPC, electronic HMPC, and hard-stop HMPC. Chi-square and binomial tests compared CHLA's CAC-3 compliance rates within intervention windows as well as to the national average. Results. Between October 2008 and May 2009, CHLA had a compliance rate of 39%, well below the national average ( p = .001). Involvement of CCCs increased the overall compliance to 74% (χ 2 (1) = 11.59, p < .001). Implementation of an electronic HMPC in October 2010 led to the largest increase in overall compliance (93%) when compared to the previous intervention window (χ 2 (1) = 4.38, p < .036), as well as the national average ( p = .016). Compliance rates remained above 90% for four out of the following five quarters. Conclusions. Involvement of CCCs led to a significant increase in the overall CAC-3 compliance. An electronic HMPC improved rates well above the national average. This provides a framework for other institutions that may or may not utilize an electronic medical record.