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Children's Asthma Care
Core Measures
Follow -Up
Team Membership
Dee Kaupie RCP, AE-C, NPS
Michael Wall, PharmD
Kathleen Webster, MD
Lindy Champa, RN
Confidential: Quality Improvement Material
Aim Statement
To improve the quality and efficiency of care
To provide education for all pediatric patients
with the primary diagnosis of asthma
To utilize evidence based medicine and to be
prepared for core measures
To meet 100% compliance with each of the
JCAHO instituting Core Measures for Asthma
 Use of Bronchodilators (relievers)
 Use of Steroids (controllers)
 Home Management Plan of Care (HMPC)
specific to the patient
Confidential: Quality Improvement Material
Background
• Most common childhood chronic illness
• 4-5 million children in the U.S. suffer from asthma
• 200,000 admissions in the U.S. annually
• 3 billion dollars in healthcare cost per year
Confidential: Quality Improvement Material
Promoting Awareness
• Imagine if you experienced shortness of
breath from simply being outside,
changes in weather, exposures to
animals, pollen, dust, molds…
• Imagine what “takes your breath away”
as not the experience of awesome
beauty…but a frightening asthma attack
Confidential: Quality Improvement Material
Action
•
Taskforce commissioned by senior executives to standardize care and enhance
quality for DRG 98 (Asthma, Bronchitis < 17 years old)
•
Multidisciplinary taskforce assessed current evidence in practice
•
Developed standardized order set for children 2 through 17 years old whose
primary reason for admission was asthma
•
Dee Kaupie, Neonatal/Pediatric Respiratory Care
Coordinator, became certified as an Asthma Educator
to provide standardized asthma education for Pediatric
In-Patients given by MDs, RCPs & RNs
Confidential: Quality Improvement Material
Implementation of Standard of Care
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Standardized order set implemented in Epic
Asthma Action Plan (HMPC) was developed and implemented via Epic
Standardized patient/family education in the proper self-care steps they should take in
living with their asthma
Results:
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Efficiency
Core measure outcomes
Bronchodilators (Reliever Medications)
received during hospitalization
Corticosteroids (Controller Medications)
received during hospitalization
HMPC as a separate document, specific to the patient and present in the medical record
that contains the five core measure components: Use of Reliever medications, Use of
Rescue medications, Avoidance of environmental triggers, Written information
indicating when to take action, what specific steps to take, and contact information to be
used, when an asthma attack occurs or is about to occur, Appointment for follow-up care
with a healthcare provider has been made
Given to the patient/caregiver, prior to or upon discharge
Confidential: Quality Improvement Material
Children's Asthma Care - Use of Relievers
100
80
Percent
60
40
20
)
(n
=1
08
(n
D
ec
20
08
20
ov
N
=3
3)
2)
=2
(n
8
0
O
ct
20
20
ep
S
ug
A
8)
(n
08
(n
08
20
00
l2
Ju
=2
2)
=1
=5
(n
8
08
Ju
n
20
08
20
ay
M
)
4)
(n
=
(n
(n
8
0
20
pr
A
=
12
)
3)
=1
4)
=
(n
08
20
ar
M
eb
F
n
20
20
08
08
(n
(n
=
=
4)
9)
)
(n
Ja
ec
D
20
ov
20
07
07
(n
(n
7
N
=4
1)
=2
=2
4)
6)
0
O
ct
20
20
ep
S
A
ug
20
07
07
(n
(n
(n
7
00
l2
Ju
=1
=7
=5
)
)
0
Month
Definition: Asthma inpatients under 18 years with documentation in the hospital record that inhaled relievers were provided during
hospitalization / all Asthma inpatients under 18 years.
Datasource: Original data extracted from LUMC charts by neonatal / pediatric respiratory care practitioner.
Analysis: LUMC performance has been at 100% since July 2007.
Confidential: Quality Improvement Material
Children's Asthma Care - Use of Systemic Corticosteroids
UCL = 105.7
100 Mean = 99.5
LCL = 93.3
80
Percent
60
40
20
)
(n
=1
08
(n
D
ec
20
08
20
ov
N
=3
3)
2)
=2
(n
8
0
O
ct
20
20
ep
S
ug
A
8)
(n
08
(n
08
20
00
l2
Ju
=2
2)
=1
=5
(n
8
08
Ju
n
20
08
20
ay
M
)
3)
(n
=
(n
(n
8
0
20
pr
A
=
12
)
2)
=1
4)
=
(n
08
20
ar
M
eb
F
n
20
20
08
08
(n
(n
=
=
4)
9)
)
(n
Ja
ec
D
20
ov
20
07
07
(n
(n
7
N
=4
1)
=2
=2
4)
6)
0
O
ct
20
20
ep
S
A
ug
20
07
07
(n
(n
(n
7
00
l2
Ju
=1
=7
=5
)
)
0
Month
•
•
•
Definition: Asthma inpatients under 18 years with documentation in the hospital record that systemic (oral, intravenous,
or intramuscular) corticosteroids were provided during hospitalization / all Asthma inpatients under 18 years.
Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory care practitioner.
Analysis: Corticosteroids were missed for one patient in September 2007. This case has already been reviewed and
feedback provided to clinicians.
Confidential: Quality Improvement Material
Conclusions
• Meeting goal for bronchodilators (relievers) and
steroids (controllers)
• Asthma Action Plan improvement:
– Identification of formatting issues and improvement
made to the HMPC template in EPIC.
– Teaching tool developed for the pediatric residents to
refer to in order to understand what the core measures
are and where to locate and document the HMPC in
EPIC.
Next Steps
•
•
•
Develop universal Asthma Action Plan that can be used in the
inpatient, the emergency department and the primary care centers.
Continue orientation of Asthma Education to new pediatric
residents
Monitor the effectiveness of the asthma education by researching
patient data.
Confidential: Quality Improvement Material
No matter who, what or where
Every living being shares
In the rhythm of breathing
The free flowing tide of air