eMeasure Title Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver
eMeasure Identifier
(Measure Authoring Tool)
26 eMeasure Version number 1
NQF Number 0338 GUID e1cb05e0-97d5-40fc-b456-15c5dbf44309
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Joint Commission
Measure Developer Joint Commission
Endorsed By National Quality Forum
Description
An assessment that there is documentation in the medical record that a Home Management Plan of Care (HMPC) document was given to the pediatric asthma patient/caregiver.
Copyright
LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Asthma is the most common chronic disease in children and a major cause of morbidity and health care costs nationally (Adams, et al., 2001). For children, asthma is one of the most frequent reasons for admission to hospitals (McCormick, et al., 1999). Silber, et al., (2003) noted that there are approximately 200,000 admissions for childhood asthma in the United States annually, representing more than $3 billion dollars in expenditures. Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. Guidelines developed by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung and Blood Institute (NHLBI), as well as by the American Academy of Pediatrics (AAP) for the diagnosis and management of asthma in children, recommend establishing a plan for maintaining control of asthma and for establishing plans for managing exacerbations. Both aspects of care would include instructions related to pharmacotherapy and assessment of lung function. 

According to the Agency for Healthcare Research and Quality (AHRQ), an Evidence-based Practice Center (EPC) and Aronson, Lefevere, Piper, et al. (2001) reported that increasing use of controller medications improves outcomes. Children with asthma who are seen by specialists or receive follow-up appointments are more likely to use appropriate long-term control medications (ACQA, 2004; Finklestein, Lozano, Farber, et al., 2002). 

Organization of care towards patient self-management and patient/caregiver routine education on appropriate use of asthma medications, identification of symptoms of exacerbation, avoidance of environmental triggers cannot be overemphasized (AHRQ, 2005). For children, it is particularly important to involve both the patient and the caregiver in this educational component of asthma care as participation in the plan of care by both will provide the greatest opportunity to promote compliance with the treatment plan, control of asthma, and treatment of exacerbations in a safe and timely manner.
Clinical Recommendation Statement
Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. National guidelines for the diagnosis and management of asthma in children, recommend establishing a plan for maintaining control of asthma and for establishing plans for managing exacerbation.
Improvement Notation
An increase in the rate.
Reference
Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and Weiss ST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma in Managed Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507.
Reference
Aronson N, Lefevere F, Piper M, et al. (September 2001). Management of chronic asthma. Evidence Report/Technology Assessment Number 44. (Prepared by Blue Cross and Blue Shield Association Technology Evaluation Center under Contract No. 290-97-0015.) AHRQ Pub. No. 01-E044. Rockville (MD): Agency for Healthcare Research and Quality.
Reference
Asthma Care Quality Assessment Study (ACQA) (1998-2003). Asthma care quality in varying managed care Medicaid plans. Harvard Medical School. Grant No. U01-HS09935.
Reference
Asthma Management Model System, http://www.nhlbi.nih.gov
Reference
Bhogal S, Zemek R, Ducharme FM, Written action plans for asthma in children.  Cochrane Database Syst Rev. 2006 Jul 19;3:CD005306.
Reference
Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium of Evidence-Based Research for Pediatric Practice. American Academy of Pediatrics (1999).
Reference
Crain EF, Weiss KB and Fagan MJ (1995). Pediatric Asthma Care in U.S. Emergency Departments. Archives of Pediatric and Adolescent Medicine. 149, 893-901.
Reference
Ducharme FM, Bhogal SK. The role of written action plans in childhood asthma.  Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):177-88.
Reference
Finkelstein JA, Lozano P, Farber HJ, et al. (2002). Underuse of controller medications among Medicaid-insured children with asthma. Arch Pediatr Adolesc Med 156(6):562-7.
Reference
McCormick MC, Kass B, Elixhauser A, Thompson J and Simpson L (2000). Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States – 1999. Pediatrics, 105:1, 219-230.
Reference
National Asthma Education and Prevention Program, http://www.nhlbi.nih.gov
Reference
National Institutes of Health, National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma, National Institutes of Health, Bethesda (2007) NIH publication no. 07-4051.
Reference
Schramm CM, Carroll CL. Advances in treating acute asthma exacerbations in children.  Curr Opin Pediatr. 2009 Jun;21(3):326-32.
Reference
Silber JH, Rosenbaum PR, Even-Shoshan O, Shabbout M, Zhang X, Bradlow ET, and Marsh RR (2003). Length of Stay, Conditional Length of Stay, and Prolonged Stay in Pediatric Asthma. Health Services Research, 38: 3, 867-886.
Reference
Stanton MW, Dougherty D, Rutherford MK. (2005). Chronic care for low-income children with asthma: strategies for improvement. Rockville (MD): Agency for Healthcare Research and Quality. Research in Action Issue 18. AHRQ Pub. No. 05-0073.
Definition
None
Guidance
The home management plan of care document should be a separate and patient-specific written instruction. The document must be present in the form of an explicit and separate document specific to the patient rather than components or segments of the plan spread across discharge instruction sheets, discharge orders, education sheets, or other instruction sheets.

The home management plan of care is represented in the eMeasure logic by a LOINC code for an asthma action plan document. This form, or equivalent, contains most of the components required for the home management plan of care, including information on:
•	Methods and timing of rescue actions: the home management plan of care addresses what to do if asthma symptoms worsen after discharge, including all of the following: 1) When to take action, i.e., assessment of severity (e.g., peak flow meter reading, signs and symptoms to watch for); 2) What specific steps to take, i.e., initial treatment instructions (e.g., inhaled relievers up to three treatments of 2-4 puffs by MDI at 20-minute intervals or single nebulizer treatment); 3) Contact information to be used, when an asthma attack occurs or is about to occur.
•	Appropriate use of long-term asthma medications (controllers), including the medication name, dose, frequency, and method of administration.
•	Appropriate use of rescue, quick-relief, or short acting medications of choice to quickly relieve asthma exacerbations (relievers), including the medication name, dose, frequency, and method of administration.
•	Environmental control and control of other triggers: information on avoidance or mitigation of environmental and other triggers.

In addition to the information outlined in the asthma action plan form (or equivalent document), the home management plan of care is required to include information regarding arrangements for referral or follow-up care with a healthcare provider, namely:
•	If an appointment for referral or follow-up care with a healthcare provider has been made, the home management plan of care is required to include the provider/clinic/office name, as well as the date and time of the appointment.
•	If an appointment for referral of follow-up care with a healthcare provider has NOT been made, the home management plan of care is required to include information for the patient/caregiver to be able to make arrangements for follow-up care, i.e., provider/clinic/office name, telephone number and time frame for appointment for follow-up care (e.g., 7-10 days).

The home management plan of care can only be considered to comply with the criteria outlined in the measure logic if it meets the requirements outlined above and is appropriately filled-out with information specific to the patient.

Patient refusal includes refusal by a caregiver. The caregiver is defined as the patient’s family or any other person (e.g., home health, VNA provider, prison official or other law enforcement personnel) who will be responsible for care of the patient after discharge.

The “Discharge To Home Or Police Custody” value set also intends to capture the following discharge disposition values:
• Assisted Living Facilities
• Court/Law Enforcement – includes detention facilities, jails, and prison
• Home – includes board and care, foster or residential care, group or personal care homes, and homeless shelters
• Home with Home Health Services
• Outpatient Services including outpatient procedures at another hospital, Outpatient Chemical Dependency Programs and Partial Hospitalization.

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.
Transmission Format
None
Initial Patient Population
Pediatric asthma inpatients with an age of 2 through 17 years, and length of stay less than or equal to 120 days.
Denominator
Pediatric asthma inpatients with an age of 2 through 17 years, length of stay less than or equal to 120 days, and discharged to home or police custody.
Denominator Exclusions
None
Numerator
Pediatric asthma inpatients with documentation that they or their caregivers were given a written Home Management Plan of Care (HMPC) document that addresses all of the following: 
1. Arrangements for follow-up care 
2. Environmental control and control of other triggers
3. Method and timing of rescue actions
4. Use of controllers 
5. Use of relievers
Numerator Exclusions
Not applicable
Denominator Exceptions
None
Measure Population
Not applicable
Measure Observations
Not applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
eMeasure Children’s Asthma Care (eCAC)