Team Membership Dee Kaupie RCP, AE-C Sandy Swanson, RN Michael Wall, PharmD Kathleen Webster, MD...

Team Membership

Dee Kaupie RCP, AE-CSandy Swanson, RN

Michael Wall, PharmDKathleen Webster, MD

Children's Asthma Care Children's Asthma Care Core MeasuresCore Measures

Confidential: For Quality Improvement Purposes Only

Aim Statement

To improve the To improve the qualityquality and and efficiencyefficiency of care of care

To provide To provide educationeducation for all pediatric patients for all pediatric patients with the primary diagnosis of asthma with the primary diagnosis of asthma

To utilize evidence based medicine and to beTo utilize evidence based medicine and to be prepared for core measuresprepared for core measures

To meet 100% compliance with each of theTo meet 100% compliance with each of the JCAHO instituting Core Measures for AsthmaJCAHO instituting Core Measures for Asthma

Use of Bronchodilators (relievers)Use of Bronchodilators (relievers) Use of Steroids (controllers)Use of Steroids (controllers) Home Management Plan of Care (HMPC)Home Management Plan of Care (HMPC) specific to the patientspecific to the patient


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


Promoting Awareness

• Imagine if you experienced shortness of breath from simply being outside, experiencing a change in weather, or petting the family dog

• Imagine what “takes your breath away” is not an awesome experience of beauty…but a frightful experience of an asthma attack


• Taskforce commissioned by senior executives to standardize care and enhance quality for DRG 98 (Asthma, Bronchitis < 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 MDs, RCPs & RNs

ActionAction


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 all five components and given to the patient/caregiver, prior to or upon discharge.


Per

cen

tCore Measures

Children's Asthma Care - Use of Relievers

Month

Jul 2

007

(n=5

)

Aug 200

7 (n

=7)

Sep 2

007

(n=1

6)

Oct 2

007

(n=2

4)

Nov 20

07 (n

=21)

Dec 2

007

(n=4

)

Jan 2

008

(n=9

)

Feb 2

008

(n=4

)

Mar

200

8 (n

=4)

0

20

40

60

80

100

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. NAEPP, NHLBI & AAP recommend the use of relievers to gain control of acute asthma exacerbations & reduce severity as quickly as possible, with step down medication to least medication necessary to maintain control.

Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory therapist.

Analysis: LUMC performance has been at 100% since July 2007.


Per

cen

tCore Measures

Children's Asthma Care - Use of Systemic Corticosteroids

Month

Jul 2

007

(n=5

)

Aug 200

7 (n

=7)

Sep 2

007

(n=1

6)

Oct 2

007

(n=2

4)

Nov 20

07 (n

=21)

Dec 2

007

(n=4

)

Jan 2

008

(n=9

)

Feb 2

008

(n=4

)

Mar

200

8 (n

=4)

0

20

40

60

80

100

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. NAEPP, NHLBI & AAP recommend the use of systemic corticosteroids to gain control of acute asthma exacerbation and reduce severity as quickly as possible in children with mild, moderate and sere persistent asthma.

Data source: Original data extracted from LUMC charts by neonatal / pediatric respiratory therapist.

Analysis: LUMC performance has been at 100% since July 2007, with the exception of one patient.


• Definition: Home Management Plan of Care (HMPC) is a written asthma action plan that includes instructions for both daily actions to keep asthma controlled and for actions to adjust treatment when symptoms or exacerbations occur

• 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.

Per

cen

tCore Measures

Children's Asthma Care - Home Management Plan of Care

Month

Oct 2

007

(n=2

4)

Nov 20

07 (n

=21)

Dec 2

007

(n=4

)

Jan 2

008

(n=9

)

Feb 2

008

(n=4

)

Mar

200

8 (n

=4)

0

20

40

60

80

100


Per

cen

tCore Measures

Children's Asthma Care - Home Management Plan of Care

Month

HMPC Given to PatientHMPC Addresses ControllersHMPC Addresses When to Take ActionHMPC Addresses Reliever MedicationsHMPC Addresses TriggersHMPC Addresses Follow-up

Nov 20

07 (n

=21)

Jan 2

008

(n=9

)

Feb 2

008

(n=4

)

Mar

200

8

(n=4

)

0

20

40

60

80

100

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 relieversData 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.


Improved Efficiency

Definition: Patients included in DRG 098 (Bronchitis/Asthma years 0-17)Data source: UB-04 Hospital billing as risk-adjusted by University HealthSystem Consortium.Analysis: Cost and Length of stay were each reduced from 2003 to 2007 through a series of efforts in Pediatrics.

**Actual cost was significantly greater than expected in 2003, and is now significantly below expected in 2007.

2.1

2.2

2.3

2.4

2.5

2.6

2.7

Day

s

CY2003 (n=341) CY2007 (n=327)

Reduced Length of Stay

Length of Stay (Expected) Length of Stay (Actual)

$-

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

Dol

lars

CY2003 (n=341) CY2007 (n=327)

Reduced Cost

Cost per Admission (Expected) Cost per Admission (Actual)

****


Conclusions

• Make Asthma Action Plan accessible to outpatient chart

• Continue orientation of Asthma Education to new pediatric residents

• Monitor the effectiveness of the asthma education– Create educational bridge from the inpatient

to the outpatient Loyola Medicine network

Next Steps

• Meeting goal for bronchodilators (relievers) and steroids (controllers)

• Asthma Action Plan still is a challenge– Work with Epic to improve template

No matter Who, What, WhereEvery single person in the world

SharesIn the rhythm of breathingThe free flowing tide of air”


Team Membership Dee Kaupie RCP, AE-C Sandy Swanson, RN Michael Wall, PharmD Kathleen Webster, MD...

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