QualityProject Home Management of Asthma in Pediatric Patients

Problem Statement

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

Specific Goal:

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) to all pediatric asthma inpatients prior to discharge from the hospital.

Measure(s): 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

Intervention

Plan: develop smoking cessation counseling script

Do: offer 10-15 minute smoking cessation counseling and prescription for Chantix to first 10 patients who present Study: evaluate effectiveness of counseling and evaluate whether or not prescriptions are filled

Act: either revise counseling script (if needed), or implement to all new patients presenting for periodontal care