Improving home management plan of care compliance rates through an electronic asthma action plan

J Asthma. 2013 Aug;50(6):664-71. doi: 10.3109/02770903.2013.793708. Epub 2013 May 28.


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.

MeSH terms

  • Adolescent
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Electronic Health Records
  • Guideline Adherence
  • Home Care Services*
  • Hospitals, Pediatric / standards*
  • Humans
  • Quality of Health Care