Asthma Home Management Plan of Care. Lourdes Fernandez, MSN, RN-BC Clinical Information Specialist

Transcription

1 Asthma Home Management Plan of Care Lourdes Fernandez, MSN, RN-BC Clinical Information Specialist

2 Asthma Home Management Plan of Care

3 Asthma Background Asthma is the most common chronic condition of childhood and a major contributor to pediatric morbidity. One out of five children in Florida have lifetime asthma 1. In the pediatric population, asthma is one of the most frequent reasons for hospitalizations, accounting for close to 200,000 admissions, at a cost of $3 billion annually 1. Under-treatment and poor follow-up after discharge from hospitalizations, lead to poor control and increase risk of complications. 1 Forrest, J, Dudley, J. (2013, September). Burden of Asthma in Florida. Florida Health. Retrieved July 7 th, 2017 from

4 Asthma Background What are the Children s Asthma Core (CAC 1-3) Measures? In 2007, a set of initiatives were launched to examine children s asthma performance measures, specifically looking for quantifiable data that would help establish a baseline quality measurement of the inpatient management of asthma 1. Core Measure #1- Use of Reliever Core Measure #2- Use of Systemic Corticosteroid Core Measure #3- Home Management Plan of Care 1 Fassl, B. A., Nkoy, F. L., Stone, B. L., Srivastava, R., Simon, T. D., Uchida, D. A., Koompmeiners, K., Greene, T., Cook, L. J., Maloney, C. G. (2012, September). The Joint Commission Children s Asthma Care Quality Measures and Asthma Readmissions. Journal of the American Academy of Pediatrics. Retrieved on July 7 th, 2017 from

5 Asthma Background Call to Action The Burden of Asthma written by Florida Department of Health in 2013 was a Call to Action for health care providers and hospitals. Two of those actions called for: Assessment of readmission rates at different time intervals. Ensure patients have an Asthma Action Plan Dudley, J. & Forrest, J. (2013). Burden of Asthma. Retrieved on July 7th, 2017 from

6 Asthma Local Problem Local Problem Elevated asthma readmission rates. Children s Asthma Core measure 3 compliance 75%. Higher costs Goal Average cost for an inpatient asthma readmission - $ Increase Children s Asthma Core measure 3 compliance from 75% to 100%. Reduce asthma readmission rates and costs. 1 Hyer, R. (2011, August). Inpatient Treatment of Asthma Is Costly. Engage Healthcare Communications, LLC. Retrieved on July 7 th, 2017 from

7 Asthma Design & Implementation Project Team Respiratory Unit RN Respiratory Unit Clinical Specialist PICU RN Pulmonologist Hospitalist Chief Resident Parent Advisory* Information Technology Pharmacy Informatics Respiratory Therapist Director of Quality Risk Manager Education

8 Asthma Design & Implementation Overview: Year-long design and implementation process Monthly project team meetings LightHouse assisted in meeting the first 2 CAC measures What is LightHouse? Cerner Quality & Process Improvement Application Measure 1 Use of a Reliever Measure 2 Use of a Systemic Corticosteroid CAC Measure 3 Asthma Home Management plan of care form optimized to an electronic form

9 Asthma How Health IT was Utilized ❶ ❷ Provider places Asthma order set containing the Children s Asthma Quality Measure Dashboard

10 Asthma How Health IT was Utilized ❸ Asthma order set contains a link to Zynx Health Evidence Based Information (guidelines for diagnosis and management of Asthma).

11 Asthma How Health IT was Utilized ❹ ❺ ❻ Clinical Specialist reviews Asthma Quality Measure dashboard daily to ensure compliance.

12 Asthma How Health IT was Utilized ❼ When the provider places the Asthma Discharge Diagnosis, the system will trigger an Asthma Action Plan Alert to remind the provider to complete the Asthma Action Plan form.

13 Asthma How Health IT was Utilized ❼ The alert allows the provider to view the reference information and/or complete the Asthma Action Plan.

14 Asthma How Health IT was Utilized ❽ Asthma Action Plan form is completed.

15 Asthma How Health IT was Utilized ❾ In order to ensure that all medications ordered match those in the Asthma Action Plan, the system will trigger an alert if medications are ordered after the plan is completed.

16 Asthma How Health IT was Utilized Pre Asthma Home Management Plan of Care Form Difficult to read. Not patient/family friendly.

17 Asthma How Health IT was Utilized ❿ Patient/Parent/Guardian Asthma Home Care Plan

18 Asthma Value Derived: Compliance CHILDREN S ASTHMA CORE-3 COMPLIANCE CAC-3 Compliance Expon. (CAC-3 Compliance) 75% 87% 100% 100% Q1

19 Asthma Value Derived: Patient Safety 100 Asthma Implementation Asthma Admissions Total Asthma Admissions Total Asthma Readmissions

20 Asthma Implementation Asthma Value Derived: Patient Safety % of Asthma Readmissions % 18% 16% 14% 12% 10% 8% 6% % 2.25% 2.27% 0.65% 0.87% 1.14% 2.65% 1.54% 4% 2% 0 0% Total Asthma Admission % of Asthma Readmissions Log. (% of Asthma Readmissions)

21 Asthma Value Derived: Patient Safety 30 Total Asthma Readmissions Asthma Implementation Total Asthma Readmissions Expon. (Total Asthma Readmissions) Reduction in Asthma Readmission Rates

22 Asthma Value Derived: Finance 7 6 Asthma Implementation $35,468 Asthma Readmission Costs $40,000 $35, $23,645 $23,645 $23,645 $17,734 $11,823 $11,823 $5, Q Q Q Q Q Q Q Q $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 $0 Total Asthma Readmissions Log. (Total Asthma Readmission Costs) Total Asthma Readmission Costs

23 Asthma Readmission Costs $88, Asthma Value Derived: Finance $65, Total Asthma Readmission Asthma Readmission Costs Cost Savings

24 Asthma Surveillance The Asthma Quality Measure dashboard is used on a daily basis to monitor compliance by the providers and clinical specialist of each intensive care and medicalsurgical unit. The Asthma Measure compliance is also reported and available in the organization s web portal for all staff to view.

25 Asthma Summary Providing an asthma home management plan of care, which provides the information needed to manage symptoms and triggers at home, helped decrease asthma readmissions. The less frequent a family has loved one hospitalized, the less work days/school days are missed and the more satisfied they are with their care. Providing patients and families with the knowledge to manage their own care the more empowered they are as healthcare consumers.

26 Thank you!