Quality measure compliance for children’s asthma care reduces hospital readmissions | Agency for Healthcare Research & Quality (AHRQ)

Quality measure compliance for children’s asthma care reduces hospital readmissions | Agency for Healthcare Research & Quality (AHRQ)

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Quality measure compliance for children’s asthma care reduces hospital readmissions

Child/Adolescent Health

Increasing provider compliance with the Joint Commission’s three quality measures for children’s inpatient asthma care by use of a standardized care process model (CPM) can significantly reduce hospital readmissions for asthma, according to a new study. Because the first two quality measures (CAC-1, percentage of patients who received beta agonists, and CAC-2, percentage of patients who received systemic steroids) were already achieved in at least 99 percent of cases in the study at baseline, only the implementation of care process changes to increase patient discharges with a home management plan of care (CAC-3) reduced 6-month asthma rehospitalizations.
The researchers analyzed data on 1,865 children hospitalized for asthma at a children’s hospital during a 6-year period—754 during preimplementation of the CPM (January 2005–December 2007), 438 during CPM implementation (January 2008–March 2009), and 673 during postimplementation (April 2009–December 2010). CAC-3 was fully implemented in 0.4 percent of cases during preimplementation, but in 86.5 percent of cases during the postimplementation phase.
The 6-month asthma readmission rates dropped from an average of 17 percent before CPM implementation to 12 percent during the postimplementation phase, but not until 9 months of sustained high compliance with CAC-3. The researchers suggest that because of existing high compliance with CAC-1 and -2 at baseline, their use as quality measures needs to be reconsidered. They used data from a large tertiary academic children’s hospital in Salt Lake City to compare outcomes before and after implementing the asthma CPM. The study was funded in part by AHRQ (HS18166 and HS18678).
More details are in “The Joint Commission Children’s Asthma Care quality measures and asthma readmissions,” by Bernhard A. Fassl, M.D., Flory L. Nkoy, M.D., M.S., M.P.H., Bryan L. Stone, M.D., M.S.C.I., and others in the September 2012 Pediatrics 130(3), pp. 482-491.

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Current as of May 2013

Internet Citation: Quality measure compliance for children’s asthma care reduces hospital readmissions: Child/Adolescent Health. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/research-activities/13may/0513RA26.html

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Research Proposal on Estimating the Impact of Improving Inhaler Techniques for Asthmatic Patient

Post Title: Research Proposal on Estimating the Impact of Improving Inhaler Techniques for Asthmatic PatientDate Added: October 14th, 2011Posted in Objectives Of The Study ExamplesTags: Asthmatic, Estimating, Impact, Improving, Inhaler, patient, Proposal, Research, Techniques Summary : Estimating the Impact of Improving inhaler Techniques for Asthmatic Patient Introduction Most of the victims of asthma are children and their population is growing faster. Although there is a continuous innovation of medicines every year, parents and people are underestimating its effectiveness on children. Through this rationale, this paper proposes to conduct a study that [...]
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Research Activities, May 2010: Emergency Medicine: Emergency department treatment of asthma with systemic corticosteroids is not always timely

Emergency Medicine
Emergency department treatment of asthma with systemic corticosteroids is not always timely

Each year, there are 2 million visits to emergency departments (EDs) for acute asthma attacks. Use of systemic corticosteroids (SCs) within 1 hour of ED arrival significantly improves pulmonary function and reduces the odds of hospital admission by 60 percent. However, not all asthma patients receive this treatment and, if they do, the medication may be given late in the course of the ED visit. The researchers identified 3,798 patients with acute asthma in 62 urban EDs located in 23 States. They analyzed clinical data to determine if patients had received SCs in a timely manner, specifically within 1 hour or less.

The majority of patients (67.4 percent) received SC treatment in the ED. However, more than half of treated patients (51.5 percent) got SCs more than an hour after their arrival time, with a median door-to-SC time of 62 minutes. ED physicians appropriately administered SCs to patients with more severe episodes (i.e., history of intubation for asthma, higher respiratory rate, and lower oxygen saturation). However, nonmedical factors associated with delayed SC treatment concerned the researchers. For example, patients with delayed SC treatment were more likely to be women, 40 years of age and older, and have a longer duration of symptoms.

Delayed patients also had longer ED stays and the likelihood of a delay in treatment was increased during peak ED hours. Patients who did not receive SCs were more likely to be discharged from the ED. The study was supported in part by the Agency for Healthcare Research and Quality (HS13099).

See “Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma,” by Chu-Lin Tsai, M.D., Sc.D., Brian H. Rowe, M.D., MSc., Ashley F. Sullivan, M.S., M.P.H., and Carlos A. Camargo Jr., M.D., Dr.P.H., in the October 2009 Annals of Allergy, Asthma & Immunology 103, pp. 318-324.

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Research Activities, May 2010: Emergency Medicine: Emergency department treatment of asthma with systemic corticosteroids is not always timely

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Research Activities, November 2009: Agency News and Notes: Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

Agency News and Notes
Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the Agency for Healthcare Research and Quality. The Agency’s recent data analysis revealed that the number of patients treated for mental disorders, including depression and bipolar disease, increased from 19 million to 36 million. The overall treatment costs for mental disorders rose from $ 35 billion (in 2006 dollars) to nearly $ 58 billion, making it the costliest medical condition between 1996 and 2006. In addition, the study concluded that:

Heart disease, cancer, trauma-related disorders, and asthma joined mental disorders to comprise the five most costly conditions in both 1996 and 2006.
Overall spending for heart disease treatment increased the least, from $ 72 billion in 1996 to $ 78 billion in 2006.
Spending for cancer treatment went from $ 47 billion to $ 58 billion; asthma costs rose from $ 36 billion to $ 51 billion; and the cost to treat trauma-related disorders climbed from $ 46 billion to $ 68 billion.
In terms of average per-patient cost, cancer accounted for the highest, up slightly from $ 5,067 to $ 5,178, but treatment costs for trauma and asthma rose more steeply, increasing from $ 1,220 to $ 1,953 and from $ 863 to $ 1,059, respectively. In contrast, average per-patient spending for heart conditions and mental disorders fell from $ 4,333 to $ 3,964 and $ 1,825 to $ 1,591, respectively.
These findings were based on analysis of the Medical Expenditure Panel Survey (MEPS), a detailed source of information on the health services used by Americans, how often they are used, the cost of those services, and how they are paid. For more information, go to The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitionalized Population, at http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Statistical%20Brief&opt=2&id=910.

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Research Activities, November 2009: Agency News and Notes: Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

Research Activities, December 2011: Agency News and Notes: Children"s use of asthma controller drugs doubles

Children’s use of asthma controller drugs doubles
The proportion of children who used a prescribed controller drug to treat their asthma doubled from 29 percent in 1997–1998 to 58 percent in 2007–2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). Asthma controller drugs, such as corticosteroids, control inflammation, thereby reducing the likelihood of airway spasms; asthma reliever drugs, such as short-acting beta-2-agonists, open up the airways to make breathing easier; and leukotrienes help prevent asthma symptoms from occurring.  

AHRQ also found that during the 1997–1998 and 2007–2008 timeframes:
•Use of inhaled corticosteroids, a type of controller drug, increased from 15.5 percent to 40 percent. Use of other controller drugs also increased: beta agonists (from 3 percent to 13 percent) and leukotrienes (from 3 percent to 34 percent).
•Use of reliever and oral corticosteroid drugs declined from 44 percent to 30 percent and from 17 percent to 9 percent, respectively.
•Average annual total spending for all asthma drugs more than quadrupled from $ 527 million to $ 2.5 billion.  Specifically, spending for controller drugs grew from $ 280 million to $ 2.1 billion and for reliever drugs, the increase was $ 222 million to $ 352 million (all in 2008 dollars).
•Spending for oral corticosteroids fell from $ 25 million to $ 8 million (2008 dollars).

The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey, a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, view Statistical Brief #341: Changes in Children’s Use and Expenditures for Asthma Medications, United States, 1997-1998 to 2007-2008. 

For more information, contact Bob Isquith at bob.isquith@ahrq.hhs.gov or call (301) 427-1539.

Research Activities, December 2011: Agency News and Notes: Children’s use of asthma controller drugs doubles