Team Membership

1
Children's Asthma Care Core Measures Follow -Up
Team Membership Dee Kaupie RCP, AE-C,
NPS Michael Wall, PharmD Kathleen Webster,
MD Lindy Champa, RN
Confidential Quality Improvement Material
2
Aim Statement

• To improve the quality and efficiency of care
• To provide education for all pediatric patients
• with the primary diagnosis of asthma
• To utilize evidence based medicine and to be
• prepared for core measures
• To meet 100 compliance with each of the
• JCAHO instituting Core Measures for Asthma
• Use of Bronchodilators (relievers)
• Use of Steroids (controllers)
• Home Management Plan of Care (HMPC)
• specific to the patient

Confidential Quality Improvement Material
3
Background

• Most common childhood chronic illness
• 4-5 million children in the U.S. suffer from
  asthma
• 200,000 admissions in the U.S. annually
• 3 billion dollars in healthcare cost per year

Confidential Quality Improvement Material
4
Promoting Awareness

• Imagine if you experienced shortness of breath
  from simply being outside, changes in weather,
  exposures to animals, pollen, dust, molds
• Imagine what takes your breath away as not the
  experience of awesome beautybut a frightening
  asthma attack

Confidential Quality Improvement Material
5
Bronchospasm Restricts Exhalation Airway Tightness
Hurts
Action

• Taskforce commissioned by senior executives to
  standardize care and enhance quality for DRG 98
  (Asthma, Bronchitis lt 17 years old)
• Multidisciplinary taskforce assessed current
  evidence in practice
• Developed standardized order set for children 2
  through 17 years old whose primary reason for
  admission was asthma
• Dee Kaupie, Neonatal/Pediatric Respiratory Care
• Coordinator, became certified as an Asthma
  Educator
• to provide standardized asthma education for
  Pediatric
• In-Patients given by MDs, RCPs RNs

Confidential Quality Improvement Material
6
Implementation of Standard of Care

• Standardized order set implemented in Epic
• Asthma Action Plan (HMPC) was developed and
  implemented via Epic
• Standardized patient/family education in the
  proper self-care steps they should take in living
  with their asthma
• Results
• Efficiency
• Core measure outcomes
• Bronchodilators (Reliever Medications)
• received during hospitalization
• Corticosteroids (Controller Medications)
• received during hospitalization
• HMPC as a separate document, specific to the
  patient and present in the medical record that
  contains the five core measure components Use of
  Reliever medications, Use of Rescue medications,
  Avoidance of environmental triggers, Written
  information indicating when to take action, what
  specific steps to take, and contact information
  to be used, when an asthma attack occurs or is
  about to occur, Appointment for follow-up care
  with a healthcare provider has been made
• Given to the patient/caregiver, prior to or upon
  discharge

Albuterol Steroids Trigger Avoidance Home
- Management Asthma Action Plan
Confidential Quality Improvement Material
7
Definition Asthma inpatients under 18 years with
documentation in the hospital record that inhaled
relievers were provided during hospitalization /
all Asthma inpatients under 18 years. Datasource
Original data extracted from LUMC charts by
neonatal / pediatric respiratory care
practitioner. Analysis LUMC performance has
been at 100 since July 2007.
Confidential Quality Improvement Material
8

• Definition Asthma inpatients under 18 years with
  documentation in the hospital record that
  systemic (oral, intravenous, or intramuscular)
  corticosteroids were provided during
  hospitalization / all Asthma inpatients under 18
  years.
• Data source Original data extracted from LUMC
  charts by neonatal / pediatric respiratory care
  practitioner.
• Analysis Corticosteroids were missed for one
  patient in September 2007. This case has already
  been reviewed and feedback provided to
  clinicians.

Confidential Quality Improvement Material
9
Home Management Plan of Care (HMPC) is available
in the electronic medical record
Definition Home Management Plan of Care (HMPC)
is a separate, patient specific document present
in the medical record and given to the
patient/caregiver, prior to or upon discharge
that contains all five of the following
components (1) Information that an appointment
for follow-up care with a healthcare provider has
been made, (2) Information on avoidance or
mitigation of environmental and other triggers,
(3) Include written information indicating when
to take action, what specific steps to take, and
contact information to be used, when an asthma
attack occurs or is about to occur Rescue, (4)
HMPC included information on the appropriate use
of controllers, (5) Included information on the
appropriate use of relievers Data source
Original data extracted from LUMC charts by
neonatal / pediatric respiratory therapist.
Analysis A team of physicians, respiratory
therapists, and pharmacists are actively working
to provide a useful care plan at discharge for
all children with asthma.
Confidential Quality Improvement Material
10
Conclusions

• Meeting goal for bronchodilators (relievers) and
  steroids (controllers)
• Asthma Action Plan improvement
• Identification of formatting issues and
  improvement made to the HMPC template in EPIC.
• Teaching tool developed for the pediatric
  residents to refer to in order to understand what
  the core measures are and where to locate and
  document the HMPC in EPIC.

No matter who, what or where Every living being
shares In the rhythm of breathing The free
flowing tide of air
Next Steps

• Develop universal Asthma Action Plan that can be
  used in the inpatient, the emergency department
  and the primary care centers.
• Continue orientation of Asthma Education to new
  pediatric residents
• Monitor the effectiveness of the asthma education
  by researching patient data.

Confidential Quality Improvement Material