Improving Home Management Plan of Care Compliance Rates Through an Electronic Asthma Action Plan.
J Asthma. 2013 Apr 11. Zipkin R, Schrager SM, Keefer M, Marshall L, Wu S. Children's Hospital Los Angeles ; 4650 Sunset Blvd., Los Angeles, CA 90027.
Background: In 2007, the Joint Commission (JC) mandated reporting of three children's asthma care (CAC) measures for hospitalized patients with asthma. CAC-3 focuses on hospital discharge with a comprehensive home management plan of care (HMPC) based on 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 Children's Hospital Los Angeles (CHLA) between October 2008 and January 2012. 470 patients admitted with a primary diagnosis of asthma were included. Four plan-do-study-act (PDSA) 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=0.001). Involvement of clinical care coordinators increased overall compliance to 74% (χ2(1)=11.59, p<0.001). Implementation of an electronic HMPC in October 2010 led to the largest increase in overall compliance (93%) when compared to the previous intervention window (χ2(1)=4.38, p<0.036), as well as the national average (p=.0.016). Compliance rates remained above 90% for four out of the following five quarters.
Conclusions: Involvement of clinical care coordinators led to a significant increase in 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.