QualityProject Home Management of Asthma in Pediatric Patients
Scope of problem: Asthma is the most common chronic disease in children and a major cause of morbidity and health care costs nationally. Rates of child admissions for asthma are 29.5 per 10,000, more than twice that of adults (12.5 per 10,000). Under-treatment and inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. National guidelines stress the need for the presentation of a complete HMPC upon patient discharge to the patient and caregiver that includes detailed instructions related to pharmacotherapy (e.g. inhaled corticosteroids and inhaled beta-agonists) and assessment of lung function, however a “complete” HMPC is rarely given to the patient/caregiver at discharge. Setting: Private periodontist's office
Aims: Pediatric patients admitted with a primary diagnosis of asthma will be prescribed an inhaled corticosteroid (ICS) and receive a home management plan of care (HMPC) that is a separate, stand alone document
Patient centeredness: 85% of pediatric patients admitted with a primary diagnosis of asthma will receive at or prior to discharge a HMPC that includes written information, separate and specific to the patient, on avoidance and mitigation of triggers, methods and timing of rescue actions, use of controllers, use of relievers and appointment for follow-up care.
Efficiency: 95% of patients admitted with a primary diagnosis of asthma will be prescribed an inhaled corticosteroid at or prior to discharge.
Process and Prioritization
Process Affected: Providing a complete Home Management Care Plan (HMPC)and inhaled corticosteroid prescription (ICS) to all pediatric asthma inpatients prior to discharge from the hospital.
1. Percentage of pediatric inpatients with asthma diagnosis that are prescribed inhaled corticosteroids
2. Percentage of pediatric inpatients with asthma diagnosis that recieve a complete HMPC prior to discharge
Plan: Evaluate current status of ICS prescriptions and delivery of HMPC
Do: : Prior to or at the time of discharge provide the patient/caregiver a patient specific asthma home management plan of care. A complete HMPC must contain the following information:
• a scheduled appointment for referral or follow-up care with a health care provider;
• information on the avoidance or mitigation of environmental or other triggers;
• methods and timing of rescue actions that includes when to take action, steps to take, and contact information and when to contact the physician;
• the use of controller medications that includes the medication name, dose, frequency and method of administration;
• the use of reliever medications that includes the medication name, dose, frequency, method of administration and a stepwise method of adjusting the dose and/or frequency, based on severity of symptoms;
• evidence that the HMPC was given to the patient/caregiver.
Study: Chart review to determine percentage of patients that receive ICS and HMPC
Act: Revise procedure for prescribing ICS and delivery of HMPC
1. Children's Asthma Care (CAC) Performance Measure Set http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Childrens+Asthma+Care+(CAC)+Performance+Measure+Set.htm(Accessed September 18, 2007)
2. http://www.ahrq.gov/qual/nhqr03/nhqr2003.pdf (Accessed September 18, 2007)
3. NCQA The state of health care quality: 2003. Washington, D.C.: National Committee for Quality Assurance.
4.Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed September 18, 2007)
5. Teach SJ, Crain EF, Quint DM, Hylan ML, Joseph JG. Improved asthma outcomes in a high-morbidity pediatric population: results of an emergency department-based randomized clinical trial. Arch Pediatr Adolesc Med 2006;160(5):535–41.