Asthma Quality Measures Not Linked with Reduced Readmissions

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 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.

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 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.

Source: Newswire