title: Improving home management plan of care compliance rates through an electronic asthma action plan.
abstract: BACKGROUND
  In 2007, the Joint Commission mandated reporting of three children's asthma care (CAC) measures for hospitalized patients with asthma. The third children's asthma care measure (CAC-3) focuses on hospital discharge with a comprehensive home management plan of care (HMPC) based on the clinical severity.
  
  
  OBJECTIVE
  To improve CAC-3 compliance and identify what interventions would have the most impact.
  
  
  METHODS
  This was a retrospective observational study, conducted at the Children's Hospital Los Angeles (CHLA) between October 2008 and January 2012. A total of 470 patients admitted with a primary diagnosis of asthma were included. Four Plan-Do-Study-Act cycles testing separate interventions were used throughout the study period: clinical care coordinators (CCCs), red clipboard for paper HMPC, electronic HMPC, and hard-stop HMPC. Chi-square and binomial tests compared CHLA's CAC-3 compliance rates within intervention windows as well as to the national average.
  
  
  RESULTS
  Between October 2008 and May 2009, CHLA had a compliance rate of 39%, well below the national average (p = .001). Involvement of CCCs increased the overall compliance to 74% (χ(2)(1) = 11.59, p < .001). Implementation of an electronic HMPC in October 2010 led to the largest increase in overall compliance (93%) when compared to the previous intervention window (χ(2)(1) = 4.38, p < .036), as well as the national average (p = .016). Compliance rates remained above 90% for four out of the following five quarters.
  
  
  CONCLUSIONS
  Involvement of CCCs led to a significant increase in the overall CAC-3 compliance. An electronic HMPC improved rates well above the national average. This provides a framework for other institutions that may or may not utilize an electronic medical record.
authors.affiliation: Department of Pediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. rzipkin@chla.usc.edu
authors.forename: Ronen
authors.initials: R
authors.lastname: Zipkin
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.forename: Matthew
authors.initials: M
authors.lastname: Keefer
authors.forename: Lori
authors.initials: L
authors.lastname: Marshall
authors.forename: Susan
authors.initials: S
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D019983:Guideline Adherence; D006699:Home Care Services; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D011787:Quality of Health Care