A quality improvement project to improve compliance with the joint commission children's asthma care-3 measure.

BACKGROUND AND OBJECTIVE

Since the initiation of the Children's Asthma Care (CAC) core measures in 2008, hospitals have struggled to achieve a high rate of compliance with the CAC-3 measure of the Home Management Plan of Care (HMPC). At inception of this project in 2009, the national average was 65% compliance, which has now increased to 80%. These rates are below the Hospital Corporation of America's goal of 90% compliance. Our objective was to identify potential pitfalls that interfere with compliance on CAC-3 at our institution and to devise solutions to increase compliance to >90%.

METHODS

Inpatient pediatric patients at a community teaching hospital in a predominantly rural state were included in our interrupted time-series quality improvement project from 2008 to 2011. Patients were between 2 and 17 years of age with an International Classification of Diseases, Ninth Revision (ICD-9), primary diagnosis code of asthma at time of discharge. We identified potential stumbling blocks that interfered with compliance of CAC measures and then implemented repeated Plan-Do-Study-Act (PDSA) cycles to improve processes, including redesign of the HMPC form, education, and electronic documentation tied to the discharge medication reconciliation form, which is also required by The Joint Commission.

RESULTS

We started with an average quarterly compliance of 43% with CAC-3 before our PDSA cycles. We have improved our compliance after the 2 PDSA cycles to an average of 97%.

CONCLUSIONS

By linking the HMPC form to the discharge medication reconciliation form, we were able to achieve and maintain >90% compliance with CAC-3.