title: Association between pediatric home management plan of care compliance and asthma readmission.
abstract: OBJECTIVE
  In 2007, The Joint Commission implemented three children's asthma care (CAC) measures to help improve the quality of care for patients admitted with asthma. Due to lack of consistent evidence showing a relationship between home management plan of care (HMPC) compliance and readmission rates, CAC-3 was retired in 2016. We aimed to understand the relationship between HMPC compliance and revisits to the hospital, and investigate which components of the HMPC, if any, were driving the effect.
  
  
  METHODS
  This was a retrospective cohort study at a quaternary care freestanding children's hospital, including patients between 2 and 17 years of age admitted with a primary diagnosis of asthma between January 1, 2006, and July 1, 2013. Bivariate and multiple logistic regression analyses examined effects of HMPC provider compliance on hospital readmission and emergency department utilization for asthma within 180 days of initial discharge, controlling for admission to the intensive care unit, age, gender, ethnicity, insurance type, and whether inhaled corticosteroids were prescribed.
  
  
  RESULTS
  A total of 1,176 patients were included. Those discharged with an HMPC (n = 756, of which 84% were fully compliant) were found to have significantly lower readmission rates (7 vs. 11.9%; aOR = 0.63; 95% CI, 0.41-0.95) and ED revisit rates (aOR = 0.73; 95% CI, 0.56-0.96) within 180 days of discharge.
  
  
  CONCLUSIONS
  Providing an HMPC upon discharge was found to be associated with decreased asthma readmission and ED utilization rates. This suggests that although HMPC is no longer a required measure, there may still be utility in continuing this practice.
authors.affiliation: a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Ronen
authors.initials: R
authors.lastname: Zipkin
authors.affiliation: a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Sheree M
authors.initials: SM
authors.lastname: Schrager
authors.affiliation: a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Nguyen
authors.affiliation: a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Mary Rose
authors.initials: MR
authors.lastname: Mamey
authors.affiliation: a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Banuelos
authors.affiliation: a Division of Hospital Medicine , Children's Hospital Los Angeles , Los Angeles , CA , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004777:Environment; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D044469:Racial Groups; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Asthma; children; compliance; home management plan of care; readmission