2003 Year in Review

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Can the Joint Commission improve Asthma Care
Quality? (A review of Core Measures, and
Disease-Specific Certification Implications)Kari
ssa Luckett, RN, BSN, MSW, AE-CDirector Disease
Management Wellness, Childrens Medical
CenterPresident, Asthma Coalition of Texas
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Childrens Asthma Care Core Measures

• Core measures fall under the Joint Commissions
  Specifications for National Hospital Quality
  Measures, released December 1st, 2006 for
  implementation with April 1st, 2007 Discharges
• CAC-1 Relievers administered, if not
  contraindication documented
• CAC-2 Systemic corticosteroids administered, if
  not contraindication documented
• CAC-3 Home Management Plan of Care (HMPC)
  Document Given to Patient/Caregiver

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Special Notes

• The initial CAC measure set is comprised of 3
  performance measures.
• CAC-1 and CAC-2 are NQF endorsed and on the HQA
  implementations agenda.
• CAC-3 is currently pending NQF review and
  endorsement, and is therefore implemented as a
  test measure.
• Release Notes available at
• http//www.jointcommission.org/PerformanceMeasure
  ment/Performance Measurement/ChildrensAsthmaCare
  (CAC)PerformanceMeasureSet. htm

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NACHRI as JCAHO ORYX Core Measure Performance
Measurement System (PMS)

• Announced January 11, 2007
• NACHRI was part of the CAC development through
  involvement in the Pedi-QS collaborative
• This enables participating childrens hospitals
  to collect and report all their JCAHO quality
  measures through NACHRI s Performance
  Measurement System (PMS)
• Collaborative with Quantros to provide a
  web-based data repository that will aid in
  reporting, age stratification and selection of
  charts for manual review.
• For additional information visit
  http//www.childrenshospitals.net/AM/Template.cfm?
  SectionSearch template/CM/HTMLDisplay.cfmConte
  ntID24362

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CAC-1 Relievers

• Rationale The use of relievers is a widely
  accepted practice in treating acute asthma
  exacerbations.
• Changes from 2006- administered added to
  numerator definition change in method of data
  pull.
• Measure Sub-groups
• CAC-1a Relievers for Inpatient Asthma Overall
  (Ages 2-17)
• CAC-1b Relievers for Inpatient Asthma (Ages 2-4)
• CAC-1b Relievers for Inpatient Asthma (Ages
  5-12)
• CAC-1b Relievers for Inpatient Asthma (Ages
  13-17)

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CAC-2 Systemic Corticosteroids

• Rationale The use of systemic corticosteroids
  has a been a recommendation in treating acute
  asthma exacerbations.
• by the NHLBIs National Asthma Expert Prevention
  Panel (NAEPP) since 1997.
• Changes from 2006- administered added to
  numerator definition change in method of data
  pull.
• Measure Sub-groups
• CAC-1a Systemic Corticosteroids for Inpatient
  Asthma Overall (Ages 2-17)
• CAC-1b Systemic Corticosteroids for Inpatient
  Asthma (Ages 2-4)
• CAC-1b Systemic Corticosteroids for Inpatient
  Asthma (Ages 5-12)
• CAC-1b Systemic Corticosteroids for Inpatient
  Asthma (Ages 13-17)

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CAC-3 Home Management Plan of Care

• Rationale It has long been a recommendation by
  the NAEPP that patients receive a written plan of
  care (action plan).
• The HMPC is a combination of the action plan, and
  traditional hospital discharge forms.
• Measure Elements (7)
• HMPC document given to patient/caregiver
• HMPC document present (on chart)
• HMPC document addresses appointment for
  follow-up care
• HMPC document addresses environmental control
  and control of triggers
• HMPC document addresses methods and timing of
  rescue medications
• HMPC document addresses use of relievers
• HMPC document addresses use of controllers

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The Old Action Plan
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The New Home Management Plan of Care
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Implications of CAC

• New HMPC has more of an acute care focus
• Help drive more appropriate patient follow-up
  care (Will force hospitals to engage primary
  care providers or create own clinics, with 24/7
  scheduling capabilities)
• Refined measure definitions provides more
  meaningful data (CAC-1 and CAC-2)
• Movement away from traditional action plan, may
  force hand of primary care providers to take
  greater ownership
• Creates greater opportunity with Managed Care to
  coordinate care across continuum

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CAC Concerns

• Competing priorities When a patient is admitted
  after hours, will hospital schedule an
  appointment with provider within their system or
  recommend patient call and schedule appointment
  with normal provider after discharge?
• Does mixing the traditional action plan, with a
  discharge instruction sheet create information
  overload?
• Will the more robust medication measure influence
  physician prescribing behavior?

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CAC Concerns

• Labor intensive nature of data collection for
  CAC-3. Will pediatric hospitals invest the
  resources to submit meaningful data?
• If we see a rise in Asthma Education clinics
  and/or Disease Management programs to meet CAC-3
  discharge follow-up element, how will we regulate
  quality of programs? Will these services be
  reimbursed?

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Assessing the Quality of Disease Management
Programs

• External Validation of Quality
• Joint Commission Disease-Specific Care
  Certification
• NCQA Disease Management Accreditation
• Nationally recognized evaluation focused on
• Compliance with consensus-based national
  standards
• Effective use of evidence-based clinical practice
  guidelines
• Organized approach to performance improvement
  activities

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What is Disease-Specific Care Certification?

• Voluntary evaluation of disease management and
  chronic care programs based on
• Evidence of compliance with D-SC performance
  elements
• Clinical Care
• Self-Management
• Information Management
• Performance Measurement
• Program Management
• Two Year certification
• One year certification awarded after a successful
  site review
• Additional one-year extension granted, contingent
  on continued compliance with standards and
  regular submission of performance measurement
  data to the Joint Commission
• For information http//www.jointcommission.or
  g/CertificationPrograms/Disease-SpecificCare/

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Certification vs.
Accreditation

• Unannounced Survey
• Organization-based
• Focused on quality, safe care, process and
  function
• Assess compliance with NPSG
• Pre-defined Accreditation Services (Hospital,
  Home Care, Long Term Care, etc.)

• 5 Day Short Notice before review
• Service-based
• Focused on quality, outcomes, and improving
  clinical care
• Assess compliance with NPSG as appropriate to
  service
• Voluntary, not an add on to accreditation
• Review consultative in nature
• Any condition meeting eligibility requirements
  can be certified

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Facts about Disease-Specific Certification

• In the US
• - 418 Organizations with certification
• - 578 certified programs
• - 2 National Providers Programs
• - 11 Certified Asthma Programs, of that 4
  pediatric
• In Texas
• - 23 Organizations with certification
• - 28 certified programs (3 organizations hold
  multiple)
• - 1 Certified Asthma Program (Childrens
  Medical Center, Dallas)

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Performance Measurement

• Certified Programs must declare use of National
  Guidelines, or develop own that meet the
  requirements of National Guideline Clearinghouse
  (http//www.guideline.gov/)
• Stage I Non-standardized Measures Programs are
  required to collect and analyze data on 4 or more
  performance measures.   The Joint Commission is
  not prescriptive regarding the specific measures.
• Stage II Standardized Measures Standardized sets
  of measures are identified and specified by The
  Joint Commission and external performance
  measurement experts. Currently, standardized
  measures are available for Primary Stroke Center
  certification, LVR, VAD, and Inpatient Diabetes.

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Stage I Performance Measurement - Detail

• Explicit operational definitions
• for numerator and denominator
• required for application.
• Monthly data points on
• quarterly submission.
• 4 months, or one quarter
• data now required with initial
• application.
• Measures categories Clinical,
  Administrative/Financial, Health Status,
  Perception of Care/Services.
• New requirements for 2007

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Process Improvement Plan Requirements

• Quarterly PI plan documentation that relates to
  Program Measures, or other relevant issues.
• Staff must be able to articulate program PI Plan
  and measures.
• Plan should be fluid document, with regular
  updates in progress and measures.

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Lessons Learned at Childrens Dallas

• Pursuit of Joint Commission Certification
• Unified approach to Performance measurement and
  Process Improvement planning
• Prioritized evidence-based approach
• Standardized approach to Disease management
  across various programs
• Strengthened contracting potential
• Solidified marketing message
• Application process facilitated teambuilding
  among programs

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For more Information on Disease-Specific Care
Certification

• Disease-Specific Care Certification Workshops
• Discussion of DSC requirements
• Description of the elements of a good measure
• Explanation for completing the Measurement
  Information form
• Demonstration of how DSC Certification enhances
  patient care
• 2008 Disease-Specific Care Certification Manual
• 2008 Disease-Specific Care Fall Conference
• Build a business case using the employer
  perspective
• Assess information from organizational case study
• Integrate current theories of disease
  self-management
• Evaluate useful performance measures
• For additional information visit
  http//www.jcrinc.com

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If you have additional Questions,Please feel
free to contact Karissa at214-456-8456orKarissa
.Luckett_at_childrens.com