One of three Children’s Asthma Care (CAC) core measures adopted by the Joint Commission shows no significant link between measure compliance and a decrease in asthma-related readmission or emergency care following an initial admission for treatment of asthma, according to a study in the Journal of the American Medical Association (JAMA). The study, conducted by the Child Health Corporation of America (CHCA) Research Group and a group of researchers from children’s hospitals including Nationwide Children’s Hospital is featured in the Oct. 5, 2011 issue of JAMA.
The research focused on the relationship between increased compliance with the provision of an individualized home management plan of care (CAC-3) and hospital readmission rates and post-discharge emergency department utilization rates at 7, 30 and 90 days. Over the course of the time period studied (Jan. 2008 through Dec. 2010), compliance with the measure increased in aggregate from 40.6 to 72.9 percent. However, the researchers found no statistically significant correlation between increased compliance with this measure and readmissions or emergency department visits. Although post-discharge education and follow up is an important construct to measure, the lack of an association between this specific measure and the outcomes studied highlights an opportunity for further refinement of the major pediatric core quality measure set included in the Joint Commission ORYX® initiative.
The research did not study the relationship between the other two measures in the set (use of relievers and systemic corticosteroids) because of the overall high level of performance and lack of variability in compliance among the hospitals studied. This also suggests an opportunity for further refinement and development in order to determine differences in the quality of care provided to children. The Joint Commission developed the CAC measure set in collaboration with CHCA, the National Association of Children’s Hospitals and Related Institutions (NACHRI) and Medical Management Planning, Inc.
“Quality measures, like other medical processes, require constant review and evaluation to ensure patients are receiving the best care possible,” said Gerd McGwire, MD, PhD, Section of Hospital Pediatrics at Nationwide Children’s Hospital. “The process of refinement is especially critical in children’s health care where there has not been as many quality measures widely implemented as there has been for adult care.”
The research team, which included Dr. McGwire, concluded that findings from the study suggest the CAC-3 measure may not meet all of the criteria outlined by the Joint Commission for accountability measures. As defined by the Joint Commission, accountability measures are seen as the measures that are most suitable for external and public use, such as public reporting or pay for performance. The Joint Commission defines accountability measures as “evidence-based care processes closely linked to positive patient outcomes.” The research team recommends that the home management plan for asthma care be re-evaluated to ensure that evidence-based practices are part of the plan families follow at home and that the plan is communicated effectively to enhance compliance.
“We need to continue to develop measures that ensure that children are consistently receiving high-quality care in all health care settings,” says Dr. McGwire. “In the end, this all about doing what is right for ill or injured children.”
The study, “Hospital-Level Compliance with Asthma Care Quality Measures at Children’s Hospitals and Subsequent Asthma-Related Outcomes,” can be read in its entirety at http://jama.ama-assn.org/.