title: Linking patient-centered medical home and asthma measures reduces hospital readmission rates.
abstract: OBJECTIVE
  We sought to achieve 100% compliance with all 3 Children's Asthma Care (CAC; CAC-1, CAC-2, CAC-3) measures and track attendance at follow-up appointments with the patient-centered medical home. The impact of these measures on readmission and emergency department utilization rates was evaluated.
  
  
  METHODS
  This quality improvement study evaluated compliance with CAC measures in pediatric patients aged 2 to 18 years old hospitalized with a primary diagnosis of asthma from January 1, 2008, through June 30, 2012. A multidisciplinary Asthma Task Force was assembled to develop interventions. Attendance at the follow-up appointment was tracked monthly from January 1, 2009. Readmission and emergency department utilization rates were compared between the preimplementation period (January 1, 2006, through December 31, 2007) and the postimplementation period (January 1, 2008, through June 30, 2012).
  
  
  RESULTS
  The preimplementation period included 231 subjects and the postimplementation period included 532 subjects. Compliance with CAC-3 was 95% from October 1, 2009, through June 30, 2012. Compliance with the postdischarge follow-up appointment was 69% from January 1, 2009 through September 30, 2009, increasing significantly to 90% from October 1, 2009, through June 30, 2012 (P < .001). Postimplementation readmission rates significantly decreased in the 91- to 180-day postdischarge interval (odds ratio: 0.29; 95% confidence interval: 0.11-0.78).
  
  
  CONCLUSIONS
  In children hospitalized with asthma, compliance with the asthma core measures and the postdischarge follow-up appointment with the primary care provider was associated with reduced readmission rates at 91 to 180 days after discharge. We attribute our results to a comprehensive set of interventions designed by our multidisciplinary Asthma Task Force.
authors.affiliation: Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and lbergert@kapiolani.org.
authors.forename: Lora
authors.initials: L
authors.lastname: Bergert
authors.affiliation: Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and.
authors.forename: Shilpa J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: Hawaii Pacific Health, Honolulu, Hawaii.
authors.forename: Chieko
authors.initials: C
authors.lastname: Kimata
authors.affiliation: Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii;
authors.forename: Guangxiang
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and.
authors.forename: Wallace J
authors.initials: WJ
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019983:Guideline Adherence; D006699:Home Care Services; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care; D058996:Quality Improvement
keywords: asthma; core measures; follow-up; home management plan of care; patient-centered medical home; readmission