Featured Research

from universities, journals, and other organizations

Compliance by children's hospitals with quality measure for asthma care not associated with reduced readmission rates

Date:
October 4, 2011
Source:
JAMA and Archives Journals
Summary:
Even though there has been high-compliance or improvement by children's hospitals regarding asthma care quality measures, improved compliance with providing a written home management plan upon discharge has not been associated with subsequent lower emergency department usage or asthma-related readmission rates, according to a new study.

Even though there has been high-compliance or improvement by children's hospitals regarding asthma care quality measures, improved compliance with providing a written home management plan upon discharge has not been associated with subsequent lower emergency department usage or asthma-related readmission rates, according to a study in the October 5 issue of JAMA.

The Children's Asthma Care (CAC) set of process measures evaluates at the hospital level whether patients 2 to 17 years of age admitted with an asthma exacerbation received relievers (CAC-1) and systemic corticosteroids (CAC-2) during the admission and whether they were discharged with a complete home management plan of care (HMPC) (CAC-3), according to background information in the article. "Process measures are designed to evaluate compliance with care that is expected and, when provided, should 'maximize health benefits to patients' and lead to improved clinical outcomes. Compliance of health care organizations with many hospital-level process measures has improved over time. However, their association with improved outcomes has been variable."

Rustin B. Morse, M.D., of the Phoenix Children's Hospital and University of Arizona College of Medicine, and colleagues evaluated trends in CAC measure compliance at children's hospitals and the association between CAC measure compliance and improvements in clinical outcomes. The study included administrative and CAC compliance data from 30 U.S. children's hospitals for a total of 37,267 children admitted with asthma between January 2008 and September 2010, accounting for 45,499 hospital admissions. Follow-up was through December 2010.

The minimum quarterly compliance rates that a hospital reported for CAC-1 and CAC-2 measures were 97.1 percent and 89.5 percent, respectively. Average CAC-3 compliance was 40.6 percent during the initial 3 quarters and improved to 72.9 percent during the final 3 quarters of the study. The researchers found that the average postdischarge emergency department (ED) utilization rates were 1.5 percent at 7 days, 4.3 percent at 30 days, and 11.1 percent at 90 days, while the average quarterly readmission rates were 1.4 percent at 7 days, 3.1 percent at 30 days, and 7.6 percent at 90 days.

The authors write that compliance with CAC-1 and CAC-2 was high, with little variability across hospitals, which precluded examination of their association with the specified outcomes. "… aggregate CAC-3 compliance was initially modest but improved during the study period, with substantial variation in compliance and improvement among the hospitals. We did not find a statistically significant association between aggregate CAC-3 compliance and postdischarge ED utilization or asthma-related readmission rates at 7, 30, or 90 days."

The researchers add that their findings suggest that within children's hospitals, CAC measure set compliance alone cannot serve as a means to evaluate and compare the quality of care provided for patients admitted with asthma exacerbations.

"Consideration should be given to refining the CAC-3 measure set to ensure that high-quality HMPCs are being developed using evidence-based resources and that they are conveyed to families in an effective manner. Finally, the CAC-3 measure in its current form may not meet the criteria outlined by the Joint Commission for accountability measures. Until CAC-3 compliance can be linked to improved outcomes, the Joint Commission should reconsider whether the CAC-3 component of the measure set is appropriately classified as an 'accountability measure' suitable for public reporting, accreditation, or pay for performance," the authors conclude.

Editorial: Improving Improvement for Childhood Asthma

In an accompanying editorial, Charles J. Homer, M.D., M.P.H., of the National Initiative for Children's Healthcare Quality, Harvard Medical School, and Children's Hospital Boston, writes that "measurement can play a key role in helping redress the shortcomings of the U.S. health care system, but measures must meet high standards."

"The study by Morse et al, highlighting the great value of 'postmarketing surveillance' of performance measures, demonstrates that the Joint Commission's Children's Asthma Care measure 3, an asthma discharge plan, no longer reaches this threshold and should be retired, as should the other components if the nonvariability found in this study is replicated in nonspecialty hospitals. Recent public investment in pediatric measurement development and refinement should ensure that children's health care will not be bereft of high-quality performance measures."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Rustin B. Morse, Matthew Hall, Evan S. Fieldston, Gerd Mcgwire, Melanie Anspacher, Marion R. Sills, Kristi Williams, Naomi Oyemwense, Keith J. Mann, Harold K. Simon, Samir S. Shah. Hospital-Level Compliance With Asthma Care Quality Measures at Children's Hospitals and Subsequent Asthma-Related Outcomes. JAMA, 2011; 306 (13): 1454-1460 DOI: 10.1001/jama.2011.1385
  2. Charles J. Homer. Improving Improvement for Childhood Asthma. JAMA, 2011; 306 (13): 1487-1488 DOI: 10.1001/jama.2011.1422

Cite This Page:

JAMA and Archives Journals. "Compliance by children's hospitals with quality measure for asthma care not associated with reduced readmission rates." ScienceDaily. ScienceDaily, 4 October 2011. <www.sciencedaily.com/releases/2011/10/111004162316.htm>.
JAMA and Archives Journals. (2011, October 4). Compliance by children's hospitals with quality measure for asthma care not associated with reduced readmission rates. ScienceDaily. Retrieved October 1, 2014 from www.sciencedaily.com/releases/2011/10/111004162316.htm
JAMA and Archives Journals. "Compliance by children's hospitals with quality measure for asthma care not associated with reduced readmission rates." ScienceDaily. www.sciencedaily.com/releases/2011/10/111004162316.htm (accessed October 1, 2014).

Share This



More Health & Medicine News

Wednesday, October 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Some Positive Ebola News: Outbreak 'Contained' In Nigeria

Some Positive Ebola News: Outbreak 'Contained' In Nigeria

Newsy (Sep. 30, 2014) The CDC says a new case of Ebola has not been reported in Nigeria for more than 21 days, leading to hopes the outbreak might be nearing its end. Video provided by Newsy
Powered by NewsLook.com
UN Ebola Mission Head: Immediate Action Is Crucial

UN Ebola Mission Head: Immediate Action Is Crucial

AFP (Sep. 30, 2014) The newly appointed head of the United Nations Mission for Ebola Emergency Response (UNMEER), Anthony Banbury, outlines operations to tackle the virus. Duration: 00:39 Video provided by AFP
Powered by NewsLook.com
CDC Confirms First Case of Ebola in US

CDC Confirms First Case of Ebola in US

AP (Sep. 30, 2014) The CDC has confirmed the first diagnosed case of Ebola in the United States. The patient is being treated at a Dallas hospital after traveling earlier this month from Liberia. (Sept. 30) Video provided by AP
Powered by NewsLook.com
New Breast Cancer Drug Extends Lives In Clinical Trial

New Breast Cancer Drug Extends Lives In Clinical Trial

Newsy (Sep. 30, 2014) In a clinical trial, breast cancer patients lived an average of 15 months longer when they received new drug Perjeta along with Herceptin. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins