Health Services
Asthma Quality Care Measures at Children's Hospitals
Official Title: Hospital-Level Compliance With Asthma Care Quality Measures at Children’s Hospitals and Subsequent Asthma-Related Outcomes
Research Lead: Rustin B. Morse
Study Team: Matthew Hall, Evan S. Fieldston, Gerd McGwire, Melanie Anspacher, Marion R. Sills, Kristi Willians, Naomi Oyemwense, Keith J. Mann, Harold K. Simon, Samir S. Shah
Supported by: PHIS Research Group
Dates: January 2008 to December 2010
Background
The Children’s Asthma Care (CAC) measure set is the first set of core measures specifically designed to evaluate the quality of care provided to hospitalized children with asthma. As the only pediatric Joint Commission-Accredited Hospitals core measure, it aims to evaluate hospital compliance with care that is expected and aimed at maximizing healthcare benefits to patients and improve clinical outcomes. While there has been a steady improvement in hospital-level process measure compliance, less is known about longitudinal trends across children’s hospitals and the relationship between CAC measure compliance and improvements in clinical outcomes.
The CAC measure set evaluates whether pediatric patients age 2 to 17 years admitted with asthma exacerbation received relievers (CAC-1) and systematic corticosteroids (CAC-2) during admission and whether they were discharged with a complete home management plan of care (HMPC) (CAC-3).
Aims
- To evaluate the longitudinal trends in CAC measure compliance.
- To determine if an association exists between CAC measure compliance and clinical outcomes.
Methods
Study Design: A cross-sectional study using CAC compliance data for 30 US children’s hospitals. Hospital-specific CAC measure compliance with CAC-1, CAC-2, CAC-3, were compared to the outcome measures of post-discharge ED utilization and asthma-related readmission rates at 7, 30 and 90 days.
Data Sources: Hospital-level CAC compliance data were obtained from the National Association of Children’s Hospitals and Related Institutions (NACHRI) and readmission and post discharge ED utilization data were obtained from the Pediatric Health Information System (PHIS) database.
Population: 45,499 children admitted between January 1, 2008 and September 30, 2010, with follow-up through December 31, 2010.
Results
Among children admitted to the children’s hospitals for asthma, it was found that there was high hospital-level compliance with CAC-1 and CAC-2 quality measures. The minimum quarterly measure compliance rates for these two measures by any hospital were 97.1% and 89.5%, respectively. Due to the lack of variability in CAC-1 and CAC-2 compliance, their association with specified outcomes could not be examined.
Mean CAC-3 compliance was 40.6% (95% CI, 34.1%-47.1%) and 72.9% (95% CI, 68.8%- 76.9%) for the initial and final 3 quarters of the study, respectively. The mean 7-, 30-, and 90-day post-discharge ED utilization rates were 1.5% (95% CI, 1.3%-1.6%), 4.3% (95% CI, 4.0%-4.5%), and 11.1% (95% CI, 10.5%-11.7%) and the mean quarterly 7-, 30-, and 90-day readmission rates were 1.4% (95% CI, 1.2%-1.6%), 3.1% (95% CI, 2.8%- 3.3%), and 7.6% (95% CI, 7.2%-8.1%).
There was no significant relationship between overall CAC-3 compliance and post-discharge ED utilization rates at 7 days (OR, 1.00; 95% CI, 0.98-1.02), 30 days (OR, 0.97; 95% CI, 0.90-1.04), and 90 days (OR, 0.96; 95% CI, 0.77-1.18). Overall CAC-3 compliance was not significantly associated with readmission rates at 7 days (OR, 1.00; 95% CI, 0.99-1.02), 30 days (OR, 0.99; 95% CI, 0.96-1.02), and 90 days (OR, 1.01; 95% CI, 0.90-1.12).
Policy Focus
Consideration should be given to refining CAC-3 measure set to ensure that high-quality home management plans of care (HMPC) are being developed using evidence-based resources and are conveyed to families in an effective manner. Further, until CAC-3 compliance can be linked to improved clinical outcomes, the CAC-3 component of the measure set may not be appropriate to classify as an “accountability measure” suitable for public reporting, accreditation, or pay for performance.
Dissemination
Relevant Resources
- The Joint Commission: Children’s Asthma Care (CAC) performance measure set
- National Quality Forum: NQF-Endorsed Standards.
- National Association of Children’s Hospitals and Related Institutions: Children’s Asthma Care (CAC) Core Measure Set Background.
- Agency for Healthcare Research and Quality: Understanding quality measurement.
- The Joint Commission: Specification Manual for National Hospital Inpatient Quality Measures.
- The Joint Commission: Facts about ORYX Performance Measurement Systems.
