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Rubén J. Nazario, MD, MA, FAAP
Pediatric Hospitalist
Inova Fairfax Hospital for Children

Asthma is the most common chronic condition of childhood and a major contributor to pediatric morbidity. 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. Under-treatment and poor follow-up of asthmatic patients after discharge from the hospital contribute to poor asthma control and increase the risk of complications. Furthermore, research confirms that increased use of controller medications improves outcomes, and that pediatric patients who receive follow-up appointments are more likely to appropriately use these medicines.

In 2003, The Joint Commission (TJC) launched a set of initiatives 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. The Children’s Asthma Care (CAC) Core Measure Set includes: the use of relievers for inpatient asthma (CAC-1); the use of systemic corticosteroids for inpatient asthma (CAC-2); and a home management plan of care for the patient/caregiver (CAC-3). Subsequently, CAC-3 became a production measure effective with July 1, 2008 discharges.

To date, asthma care performance measures are the only pediatric-specific quality metrics examined by TJC. It recommends that all hospitalized patients ages 2-17 with an ICD-9 principal diagnosis code of asthma should have, upon discharge, a written home management plan of care that addresses arrangements for follow-up care, environmental control and control of other triggers, method and timing of rescue actions, use of controllers and use of reliever medication.

At Inova Fairfax Hospital for Children, multiple initiatives and projects have contributed to the steady increase of our CAC-3 compliance, reaching 100% at the end of 2010. That means that every single one of the pediatric patients hospitalized with a diagnosis of asthma received appropriate follow-up instructions upon discharge, and was educated about the use of controller and rescue medications and how to avoid asthma symptom triggers.

We could not have achieved this without the coordinated efforts of all the dedicated clinicians who provide excellent asthma care to our pediatric patients. Physicians, nurses, respiratory therapists and health administrators joined together to reach this singular goal, in hopes of improving the care we deliver to our diverse patient population. Challenges remain, but continued surveillance of this achievement will bring about further improvements in the care of asthmatic patients in the hospital, and demonstrate measurable improvements in the condition of pediatric patients living with asthma.

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