Linking patient-centered medical home and asthma measures reduces hospital readmission rates.
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.
['Bergert|Lora|L|', 'Patel|Shilpa J|SJ|', 'Kimata|Chieko|C|', 'Zhang|Guangxiang|G|', 'Matthews|Wallace J|WJ|']
D000293:Adolescent D001249:Asthma D002648:Child D002675:Child, Preschool D019983:Guideline Adherence D006699:Home Care Services D006801:Humans D010359:Patient Readmission D018802:Patient-Centered Care D058996:Quality Improvement
patient-centered medical home asthma readmission follow-up core measures home management plan of care