title: Integrating the home management plan of care for children with asthma into an electronic medical record.
abstract: BACKGROUND
  Asthma exacerbation is one of the most common causes for pediatric hospitalization. One of the three Joint Commission quality measures--which has proven the most challenging--addresses the provision of a home management plan of care (HMPC) for discharge of pediatric inpatients with a primary diagnosis of asthma. A user-friendly electronic medical record (EMR)-generated HMPC was developed and implemented at Lucile Packard Children's Hospital (LPCH) Palo Alto, California, an HPMC needed to be completed before entry of an inpatient discharge order.
  
  
  METHODS
  A cohort study using historical controls was conducted in 2010-2011. Patients were eligible to receive an HMPC if they were between the ages of 2 and 17 years old at discharge, had a length of stay < 120 days, were not enrolled in clinical trials, and had the primary discharge diagnosis of asthma. These patients were identified by the EMR if this diagnosis was listed in the diagnosis list or problem list or if the asthma admit/discharge order set was initiated.
  
  
  RESULTS
  Compliance with the HMPC increased from 65.3% for the 39 months (April 1, 2007-June 30, 2010) before integration of the HMPC into EMR to 93.7% for the 18 months after integration (July 1, 2010, through December 31, 2011); p < .0001. Users of the EMR-integrated HMPC found it to be significantly easier to complete, less time-consuming, and less prone to potential errors or omission.
  
  
  CONCLUSIONS
  Lessons learned at LPCH included the need for a continuous surveillance and improvement model, which resulted in several iterations of the HMPC; the importance of soliciting user input, which resulted in improvements in work flow; and consistent support from the quality management and information technology departments, which are crucial to eliminating barriers and facilitating improvement.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. Shilpa.patel@kapiolani.org
authors.forename: Shilpa J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Longhurst
authors.forename: Anna
authors.initials: A
authors.lastname: Lin
authors.forename: Lyn
authors.initials: L
authors.lastname: Garrett
authors.forename: Jenny
authors.initials: J
authors.lastname: Gillette-Arroyo
authors.forename: John D
authors.initials: JD
authors.lastname: Mark
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Wood
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D057286:Electronic Health Records; D004777:Environment; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge; D019984:Quality Indicators, Health Care