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.
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.
Authors: Arlene M Butz; Laura Syron; Betty Johnson; Joanne Spaulding; Melissa Walker; Mary Elizabeth Bollinger Journal: Public Health Nurs Date: 2005 May-Jun Impact factor: 1.462
Authors: S B Soumerai; T J McLaughlin; J H Gurwitz; E Guadagnoli; P J Hauptman; C Borbas; N Morris; B McLaughlin; X Gao; D J Willison; R Asinger; F Gobel Journal: JAMA Date: 1998-05-06 Impact factor: 56.272
Authors: Sharon K Griswold; Carla R Nordstrom; Sunday Clark; Theodore J Gaeta; Michelle L Price; Carlos A Camargo Journal: Chest Date: 2005-05 Impact factor: 9.410
Authors: Naomi S Bardach; Eric Vittinghoff; Renée Asteria-Peñaloza; Jeffrey D Edwards; Jinoos Yazdany; Henry C Lee; W John Boscardin; Michael D Cabana; R Adams Dudley Journal: Pediatrics Date: 2013-08-26 Impact factor: 7.124
Authors: Mark I Neuman; Matthew Hall; James C Gay; Anne J Blaschke; Derek J Williams; Kavita Parikh; Adam L Hersh; Thomas V Brogan; Jeffrey S Gerber; Carlos G Grijalva; Samir S Shah Journal: Pediatrics Date: 2014-07 Impact factor: 7.124
Authors: Kohei Hasegawa; Yusuke Tsugawa; Sunday Clark; Carly D Eastin; Susan Gabriel; Vivian Herrera; Jane C Bittner; Carlos A Camargo Journal: Chest Date: 2016-04-04 Impact factor: 9.410
Authors: Achsah D Keegan; Kari Ann Shirey; Dayanand Bagdure; Jorge Blanco; Rose M Viscardi; Stefanie N Vogel Journal: Pathog Dis Date: 2016-05-12 Impact factor: 3.166
Authors: Chang Xiao; Jocelyn M Biagini Myers; Hong Ji; Kelly Metz; Lisa J Martin; Mark Lindsey; Hua He; Racheal Powers; Ashley Ulm; Brandy Ruff; Mark B Ericksen; Hari K Somineni; Jeffrey Simmons; Richard T Strait; Carolyn M Kercsmar; Gurjit K Khurana Hershey Journal: J Allergy Clin Immunol Date: 2015-04-21 Impact factor: 10.793
Authors: Michelle Y Hamline; Rebecca L Speier; Paul Dai Vu; Daniel Tancredi; Alia R Broman; Lisa N Rasmussen; Brian P Tullius; Ulfat Shaikh; Su-Ting T Li Journal: Pediatrics Date: 2018-10-23 Impact factor: 7.124