PCMH, Asthma Measures Cut Pediatric Readmissions

Diedtra Henderson

June 16, 2014

Compliance with all of the Children's Asthma Care (CAC) core measures — a trio of interventions designed to improve the care of pediatric patients hospitalized because of asthma — was associated with reduced readmission rates, according to a study published online June 16 in Pediatrics.

Lora Bergert, MD, Department of Pediatrics, University of Hawaii John A. Burns School of Medicine and Kapi'olani Medical Center for Women and Children, both in Honolulu, and coauthors report the results of the quality-improvement (QI) project aimed at decreasing readmission rates in children hospitalized for asthma.

Asthma is the most common chronic disease of childhood, affecting 9.4% children younger than 18 and accounting for more than 150,000 hospitalizations and 640,000 emergency department visits among children in 2007, the authors write. In Hawaii, one third of people diagnosed with asthma are children.

The hospital formed a multidisciplinary asthma task force that included hospital-based and community physicians, nursing leadership, respiratory therapists, the hospital chief operating officer, and a QI officer.

The 3 elements of CAC for children younger than age 18 years are bronchodilator/reliever medication use, systemic corticosteroid use, and completion of a home management plan of care (which includes a postdischarge appointment with a primary care provider and/or physician name and contact number at discharge). These measures enhance continuity of care from the inpatient to the PCMH setting, the authors write. The Kapi'olani Medical Center for Women and Children's asthma task force set its goal at 100% compliance with the CAC core measures. Hospital staff gave all children a follow-up appointment prior to discharge, even those who had no identified primary care physician on admission.

Some 763 children aged 2 to 18 years were hospitalized with a primary diagnosis of asthma during the study period: January 1, 2008, through June 30, 2012. The task force began tracking attendance at the follow-up appointment monthly from January 1, 2009. Compliance with the first 2 CAC measures held steady at greater than 99%. The third measure, follow-up appointments, rose from 74% to 95%.

"Our QI efforts revealed that in children hospitalized with an acute asthma exacerbation, compliance with both the asthma core measures and attendance at the postdischarge follow-up appointment with the PCMH was associated with reduced readmission rates at 91 to 180 days postdischarge," Dr. Bergert and colleagues write. "Our findings support the concept that continuity of care with the PCMH is beneficial in reducing medical resource utilization by children with asthma."

The authors write that such care coordination "makes good sense" and add that in Hawaii there is 1 pediatrician for every 1005 children, making it among the easiest places in the nation for children to see a clinician.

"We have shown that long-term compliance with [The Joint Commission] JC asthma core measures as well as attendance at the predischarge scheduled PCP follow-up appointment is associated with reduced readmission rates for asthma," the authors conclude. "This finding supports the notion that a smooth transition from the inpatient setting to the PCMH leads to an improvement in outcomes."

The National Institutes of Health supported the study. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 16, 2014. Abstract

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