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Children's Asthma Care
Core Measures
Team Membership
Dee Kaupie RCP, AE-C
Sandy Swanson, RN
Michael Wall, PharmD
Kathleen Webster, MD
Confidential: For Quality Improvement Purposes Only
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: For Quality Improvement Purposes Only
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: For Quality Improvement Purposes Only
Promoting Awareness
• Imagine if you experienced
shortness of breath from simply
being outside, experiencing a
change in weather, or petting the
family dog
• Imagine what “takes your breath
away” is not an awesome experience
of beauty…but a frightful experience
of an asthma attack
Confidential: For Quality Improvement Purposes Only
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 MDs, RCPs & RNs
Confidential: For Quality Improvement Purposes Only
Implementation of Standard of Care
– 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:
– 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 all five components and given to the
patient/caregiver, prior to or upon discharge.
Confidential: For Quality Improvement Purposes Only
Core Measures
Children's Asthma Care - Use of Relievers
100
80
Percent
60
40
20
Confidential: For Quality Improvement Purposes Only
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. NAEPP, NHLBI & AAP recommend the use of relievers to gain control of acute asthma exacerbations &
reduce severity as quickly as possible, with step down medication to least medication necessary to maintain control.
Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory therapist.
Analysis: LUMC performance has been at 100% since July 2007.
Core Measures
Children's Asthma Care - Use of Systemic Corticosteroids
100
80
Percent
60
40
20
Confidential: For Quality Improvement Purposes Only
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. NAEPP, NHLBI & AAP
recommend the use of systemic corticosteroids to gain control of acute asthma exacerbation and reduce severity as quickly as possible in children
with mild, moderate and sere persistent asthma.
Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory therapist.
Analysis: LUMC performance has been at 100% since July 2007, with the exception of one patient.
Core Measures
Children's Asthma Care - Home Management Plan of Care
100
80
Percent
60
40
20
Confidential: For Quality Improvement Purposes Only
0
Month
•
Definition: Home Management Plan of Care (HMPC) is a written asthma action plan that includes instructions for both daily
actions to keep asthma controlled and for actions to adjust treatment when symptoms or exacerbations occur
•
Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory therapist.
•
Analysis: A team of physicians, respiratory therapists, and pharmacists are actively working to provide a useful care plan at
discharge for all children with asthma.
Core Measures
Children's Asthma Care - Home Management Plan of Care
100
80
60
Percent
40
20
Confidential: For Quality Improvement Purposes Only
0
HMPC Given to Patient
HMPC Addresses Controllers
HMPC Addresses When to Take Action
HMPC Addresses Reliever Medications
HMPC Addresses Triggers
HMPC Addresses Follow-up
Month
Definition: Home Management Plan of Care (HMPC) is a separate, patient specific document present in the medical record and given
to the patient/caregiver, prior to or upon discharge that contains all five of the following components:
(1) Information that an appointment for follow-up care with a healthcare provider has been made
(2) Information on avoidance or mitigation of environmental and other triggers
(3) Include 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: Rescue
(4) HMPC included information on the appropriate use of controllers
(5) Included information on the appropriate use of relievers
Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory therapist.
Analysis: A team of physicians, respiratory therapists, and pharmacists are actively working to provide a useful care plan at discharge
for all children with asthma.
Improved Efficiency
Reduced Length of Stay
Reduced Cost
2.7
$4,000
**
**
$3,500
2.6
$3,000
2.5
Dollars
Days
$2,500
2.4
$2,000
$1,500
2.3
$1,000
2.2
$500
2.1
CY2003 (n=341)
CY2007 (n=327)
Length of Stay (Expected)
Length of Stay (Actual)
$CY2003 (n=341)
Cost per Admission (Expected)
CY2007 (n=327)
Cost per Admission (Actual)
Definition: Patients included in DRG 098 (Bronchitis/Asthma years 0-17)
Data source: UB-04 Hospital billing as risk-adjusted by University HealthSystem Consortium.
Analysis: Cost and Length of stay were each reduced from 2003 to 2007 through a series of efforts in Pediatrics.
**Actual cost was significantly greater than expected in 2003, and is now significantly below expected in 2007.
Confidential: For Quality Improvement Purposes Only
Conclusions
• Meeting goal for bronchodilators
(relievers) and steroids (controllers)
• Asthma Action Plan still is a challenge
– Work with Epic to improve template
Next Steps
• Make Asthma Action Plan accessible
to outpatient chart
• Continue orientation of Asthma
Education to new pediatric residents
• Monitor the effectiveness of the
asthma education
No matter Who, What, Where
Every single person in the world
Shares
In the rhythm of breathing
The free flowing tide of air”
– Create educational bridge from the
inpatient to the outpatient Loyola
Medicine network
Confidential: For Quality Improvement Purposes Only