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

Research output: Contribution to journalArticle

35 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)482-491
Number of pages10
JournalPediatrics
Volume130
Issue number3
DOIs
StatePublished - Sep 1 2012

Fingerprint

Child Care
Asthma
Joints
Hospitalization
Patient Readmission
Tertiary Healthcare
Quality Improvement
Insurance
Compliance
Inpatients
Length of Stay
Logistic Models
Pediatrics
Costs and Cost Analysis

Keywords

  • Asthma
  • Compliance
  • Hospitalization
  • Quality improvement
  • Quality of care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Fassl, B. A., Nkoy, F. L., Stone, B. L., Srivastava, R., Simon, T. D., Uchida, D. A., ... Maloney, C. G. (2012). The Joint Commission children's asthma care quality measures and asthma readmissions. Pediatrics, 130(3), 482-491. https://doi.org/10.1542/peds.2011-3318

The Joint Commission children's asthma care quality measures and asthma readmissions. / Fassl, Bernhard A.; Nkoy, Flory L.; Stone, Bryan L.; Srivastava, Rajendu; Simon, Tamara D.; Uchida, Derek A.; Koopmeiners, Karmella; Greene, Tom; Cook, Lawrence J.; Maloney, Christopher G.

In: Pediatrics, Vol. 130, No. 3, 01.09.2012, p. 482-491.

Research output: Contribution to journalArticle

Fassl, BA, Nkoy, FL, Stone, BL, Srivastava, R, Simon, TD, Uchida, DA, Koopmeiners, K, Greene, T, Cook, LJ & Maloney, CG 2012, 'The Joint Commission children's asthma care quality measures and asthma readmissions', Pediatrics, vol. 130, no. 3, pp. 482-491. https://doi.org/10.1542/peds.2011-3318
Fassl BA, Nkoy FL, Stone BL, Srivastava R, Simon TD, Uchida DA et al. The Joint Commission children's asthma care quality measures and asthma readmissions. Pediatrics. 2012 Sep 1;130(3):482-491. https://doi.org/10.1542/peds.2011-3318
Fassl, Bernhard A. ; Nkoy, Flory L. ; Stone, Bryan L. ; Srivastava, Rajendu ; Simon, Tamara D. ; Uchida, Derek A. ; Koopmeiners, Karmella ; Greene, Tom ; Cook, Lawrence J. ; Maloney, Christopher G. / The Joint Commission children's asthma care quality measures and asthma readmissions. In: Pediatrics. 2012 ; Vol. 130, No. 3. pp. 482-491.
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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.",
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