05 October 2011

Asthma home health plan for children ineffective

Researchers studying the first national quality measure for hospitalised children have found that it had no actual impact on patient outcomes.


Hospital compliance makes little difference.

Researchers studying the first national quality measure for hospitalised children have found that no matter how strictly a health care institution followed the criteria, it had no actual impact on patient outcomes.

The scientists examined 30 hospitals with 37,267 children admitted for asthma from 2008 to 2010 and discovered that the quality of discharge planning made no difference to the rate of return to the hospital for another asthma attack in 7, 30 or 90 days.

"Our research concluded that there is no relationship between compliance with this measure and readmission rates for asthma patients," said study co-author Marion Sills, MD, MPH and associate professor of paediatrics at the University of Colorado School of Medicine.

The findings have been published in the Journal of the American Medical Association (JAMA).

Asthma is the leading cause of admissions in children's hospitals. To help provide the best care, the Joint Commission, a non-profit that accredits and certifies more than 19,000 health care organisation programmes nationwide, adopted three core process measures for evaluating how hospitals treat childhood asthma.

Home management plan

The Children's Asthma Care (CAC) measures include giving asthma relievers upon admission, providing systemic corticosteroids and creating a home management plan of care when they are discharged.

Hospitals' compliance with the first two measures was high and did not vary enough for researchers to study the impact on outcomes.

By studying hospitals' compliance with the third measure – devising a home health management plan -- researchers concluded that it had no effect on hospital readmissions or return emergency department visits for asthma.

"No matter how well your hospital did in complying with this, there was no difference in readmissions," Sills said. "For a parent trying to choose a hospital for a child with an asthma attack, this quality measure doesn't help determine which hospital will provide better care."

From a policy standpoint, these measures may not meet the Joint Commission's own criteria for an accountability measure – that compliance should lead to better outcomes.

Re-evaluation of criteria 

This is especially important for measures that will be used for public reporting and pay for performance.

Requiring a hospital to meet a certain criteria of patient care and then finding out that it makes no difference is reason to re-evaluate these measures.

The findings are significant because until recently none of the more than 50 Joint Commission measures evaluated care for hospitalised children.

They have been used for numerous other conditions with varying success. For example, acute myocardial infarction mortality rates decreased but congestive heart failure death rates did not during times when compliance with process measures increased.

Sills and the other researchers concluded by saying the Joint Commission should reconsider whether a hospital's compliance with the CAC measures is suitable for public reporting, accreditation or pay for performance.

(EurekAlert, October  2011) 

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Professor Keertan Dheda has received of several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others.Read his full biography at the University of Cape Town Lung Institute

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