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Association between pediatric home management plan of care compliance and asthma readmission
Ronen Zipkin1, Sheree M Schrager1, Eugene Nguyen1
1a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
Insights
Providing a home management plan of care (HMPC) for pediatric asthma patients significantly reduced hospital readmissions and emergency department visits. This suggests the continued value of HMPC despite its retirement as a quality measure.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Asthma Management
Background:
- The Joint Commission previously mandated children's asthma care (CAC) measures, including home management plans of care (HMPC).
- CAC-3 (HMPC compliance) was retired in 2016 due to insufficient evidence linking it to reduced readmissions.
- The relationship between HMPC compliance and patient outcomes requires further investigation.
Purpose of the Study:
- To determine the association between home management plan of care (HMPC) compliance and hospital readmission rates for pediatric asthma patients.
- To investigate the impact of HMPC compliance on emergency department (ED) revisits within 180 days of discharge.
- To identify specific HMPC components influencing these outcomes.
Main Methods:
- Retrospective cohort study of 1,176 children (2-17 years) admitted for asthma between 2006 and 2013.
- Logistic regression analysis assessed HMPC compliance's effect on 180-day readmission and ED utilization.
- Controlled for ICU admission, age, gender, ethnicity, insurance, and inhaled corticosteroid prescription.
Main Results:
- Patients discharged with an HMPC (n=756, 84% compliant) had significantly lower readmission rates (7% vs. 11.9%).
- HMPC compliance was associated with reduced ED revisit rates (aOR=0.73; 95% CI, 0.56-0.96).
- Adjusted odds ratios indicated a 37% reduction in readmissions (aOR=0.63; 95% CI, 0.41-0.95) for compliant patients.
Conclusions:
- Discharge with a home management plan of care is linked to decreased asthma readmission and ED utilization in children.
- Despite no longer being a mandated measure, HMPC implementation may remain beneficial for asthma care quality.
- Further research could explore specific HMPC components driving these positive effects.
Objectives:
In 2007, The Joint Commission implemented three children's asthma care (CAC) measures to help improve the quality of care for patients admitted with asthma. Due to lack of consistent evidence showing a relationship between home management plan of care (HMPC) compliance and readmission rates, CAC-3 was retired in 2016. We aimed to understand the relationship between HMPC compliance and revisits to the hospital, and investigate which components of the HMPC, if any, were driving the effect.
Methods:
This was a retrospective cohort study at a quaternary care freestanding children's hospital, including patients between 2 and 17 years of age admitted with a primary diagnosis of asthma between January 1, 2006, and July 1, 2013. Bivariate and multiple logistic regression analyses examined effects of HMPC provider compliance on hospital readmission and emergency department utilization for asthma within 180 days of initial discharge, controlling for admission to the intensive care unit, age, gender, ethnicity, insurance type, and whether inhaled corticosteroids were prescribed.
Results:
A total of 1,176 patients were included. Those discharged with an HMPC (n = 756, of which 84% were fully compliant) were found to have significantly lower readmission rates (7 vs. 11.9%; aOR = 0.63; 95% CI, 0.41-0.95) and ED revisit rates (aOR = 0.73; 95% CI, 0.56-0.96) within 180 days of discharge.
Conclusions:
Providing an HMPC upon discharge was found to be associated with decreased asthma readmission and ED utilization rates. This suggests that although HMPC is no longer a required measure, there may still be utility in continuing this practice.
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