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J Asthma. 2013 Aug;50(6):664-71. doi: 10.3109/02770903.2013.793708. Epub 2013 May 28.

Improving home management plan of care compliance rates through an electronic asthma action plan.

Author information

1
Department of Pediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. rzipkin@chla.usc.edu

Abstract

BACKGROUND:

In 2007, the Joint Commission mandated reporting of three children's asthma care (CAC) measures for hospitalized patients with asthma. The third children's asthma care measure (CAC-3) focuses on hospital discharge with a comprehensive home management plan of care (HMPC) based on the clinical severity.

OBJECTIVE:

To improve CAC-3 compliance and identify what interventions would have the most impact.

METHODS:

This was a retrospective observational study, conducted at the Children's Hospital Los Angeles (CHLA) between October 2008 and January 2012. A total of 470 patients admitted with a primary diagnosis of asthma were included. Four Plan-Do-Study-Act cycles testing separate interventions were used throughout the study period: clinical care coordinators (CCCs), red clipboard for paper HMPC, electronic HMPC, and hard-stop HMPC. Chi-square and binomial tests compared CHLA's CAC-3 compliance rates within intervention windows as well as to the national average.

RESULTS:

Between October 2008 and May 2009, CHLA had a compliance rate of 39%, well below the national average (p = .001). Involvement of CCCs increased the overall compliance to 74% (χ(2)(1) = 11.59, p < .001). Implementation of an electronic HMPC in October 2010 led to the largest increase in overall compliance (93%) when compared to the previous intervention window (χ(2)(1) = 4.38, p < .036), as well as the national average (p = .016). Compliance rates remained above 90% for four out of the following five quarters.

CONCLUSIONS:

Involvement of CCCs led to a significant increase in the overall CAC-3 compliance. An electronic HMPC improved rates well above the national average. This provides a framework for other institutions that may or may not utilize an electronic medical record.

PMID:
23574196
DOI:
10.3109/02770903.2013.793708
[Indexed for MEDLINE]
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