Abstract
Abstract:Undocumented patient information in the medical record (MR) is a barrier to providing high quality care. Inadequate documentation has recently been reported for two cardiovascular diseases. This study was designed to evaluate the documentation of asthma management in the MR to determine if it is consistent with the NIH asthma guidelines. We performed a retrospective chart review of patients (ages 18–49) admitted to the hospital with an ICD-9 code for a primary diagnosis of asthma between January 2004 and May 2007. Patients admitted with a hospitalization for >24 hours and had <10 pack per year smoking history were included. We assessed medication regimens, documentation of asthma education, asthma action plans, referrals, and exacerbating factors. There were 233 admissions for 144 unique patients analyzed. At discharge, 85% of patients lacked documentation of asthma education, 97% lacked documentation of a written asthma action plan being given, and 79% did not have referral to an asthma specialist. Respiratory infection was the most common factor associated with admission; 58% of admissions were lacking documentation of the exacerbating factor. Only 47% of patients were receiving inhaled corticosteroids (ICS) prior to admission; 25% of patients did not have ICS prescribed for maintenance therapy upon discharge. Documentation of asthma management, specifically asthma education in the MR, is insufficient and may reflect a deficiency in care. Additionally, an inadequate number of patients were receiving ICS for maintenance therapy. Based on these findings, mechanisms are needed to ensure appropriate documentation and optimal care.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References1. National Institutes of Health, National Asthma Education Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD, National Institutes of Health, National Heart, Lung, and Blood Institute, 2007.National Institutes of Health, National Asthma Education ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.Bethesda, MDNational Institutes of Health, National Heart, Lung, and Blood Institute20072. Center for Disease Control and Prevention. Asthma Prevalence, Heath Care Use and Mortality. Center for Disease Control and Prevention, Atlanta, GA, 2002.Center for Disease Control and PreventionAsthma Prevalence, Heath Care Use and Mortality.Center for Disease Control and PreventionAtlanta, GA20023. Self TH, Chrisman CR, Mason DL, et al. Reducing emergency department visits and hospitalizations in African American and Hispanic patients with asthma: a 15-year review. J Asthma 2005;42:807–812.SelfTH]]ChrismanCR]]MasonDL&etal;Reducing emergency department visits and hospitalizations in African American and Hispanic patients with asthma: a 15-year review.J Asthma200542807-8124. Cox JL, Zitner D, Courtney KD, et al. Undocumented patient information: an impediment to quality of care. Am J Med 2003;114:211–216.CoxJL]]ZitnerD]]CourtneyKD&etal;Undocumented patient information: an impediment to quality of care.Am J Med2003114211-2165. Ilksoy N, Moore RH, Easley K, et al. Qualilty of care in African-American patients admitted for congestive heart failure at a university teaching hospital. Am J Cardiol 2006;97:690–693.IlksoyN]]MooreRH]]EasleyK&etal;Qualilty of care in African-American patients admitted for congestive heart failure at a university teaching hospital.Am J Cardiol200697690-6936. Krumholz HM, Wang Y, Parent EM, et al. Quality of care for elderly patients hospitalized with heart failure. Arch Intern Med 1997;157:2242–2247.KrumholzHM]]WangY]]ParentEM&etal;Quality of care for elderly patients hospitalized with heart failure.Arch Intern Med19971572242-22477. Wright J, Strang JR. Reducing the risk after coronary artery bypass surgery: documentation of risk factors and communication between hospital and general practice. Public Heath 1997;111:157–160.WrightJ]]StrangJRReducing the risk after coronary artery bypass surgery: documentation of risk factors and communication between hospital and general practice.Public Heath1997111157-1608. National Institutes of Health, National Asthma Education Program. Expert Panel Report 2 Update: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD, National Institutes of Health, National Heart, Lung, and Blood Institute, 2002.National Institutes of Health, National Asthma Education ProgramExpert Panel Report 2 Update: Guidelines for the Diagnosis and Management of Asthma.Bethesda, MDNational Institutes of Health, National Heart, Lung, and Blood Institute20029. Diette GB, Krishnan JA, Dominici F, et al. Asthma in older patients: factors associated with hospitalization. Arch Intern Med 2002;162:1123–1132.DietteGB]]KrishnanJA]]DominiciF&etal;Asthma in older patients: factors associated with hospitalization.Arch Intern Med20021621123-113210. Eisner MD, Katz PP, Yelin EH, et al. Risk factors for hospitalization among adults with asthma: influence of sociodemographic factors and asthma severity. Respir Res 2001;2:53–60.EisnerMD]]KatzPP]]YelinEH&etal;Risk factors for hospitalization among adults with asthma: influence of sociodemographic factors and asthma severity.Respir Res2001253-6011. Heaney LG, Conway E, Kelly C, et al. Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol. Thorax 2003;58:561–566.HeaneyLG]]ConwayE]]KellyC&etal;Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol.Thorax200358561-56612. Adams RJ, Smith BJ, Ruffin RE. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma. Thorax 2000;55:566–573.AdamsRJ]]SmithBJ]]RuffinREFactors associated with hospital admissions and repeat emergency department visits for adults with asthma.Thorax200055566-57313. McDermott MF, Lenhardt RO, Catrambone CD, et al. Adequacy of medical chart review to characterize emergency care for asthma: findings from the Illinois emergency department asthma collaborative. Acad Emerg Med 2006;13:345–348.McDermottMF]]LenhardtRO]]CatramboneCD&etal;Adequacy of medical chart review to characterize emergency care for asthma: findings from the Illinois emergency department asthma collaborative.Acad Emerg Med200613345-34814. Levine M, Iliescu ME, Margellos-Anast H, et al. The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations. Chest 2005;128:1951–1957.LevineM]]IliescuME]]Margellos-AnastH&etal;The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations.Chest20051281951-195715. Schatz M, Mosen D, Apter AJ, et al. Relationship of validated psychometric tools to subsequent medical utilization for asthma. J Allergy Clin Immunol 2005;115:564–570.SchatzM]]MosenD]]ApterAJ&etal;Relationship of validated psychometric tools to subsequent medical utilization for asthma.J Allergy Clin Immunol2005115564-57016. Schatz M, Mosen D, Apter AJ, et al. Relationships among quality of life, severity, and control measure in asthma: an evaluation using factor analysis. J Allergy Clin Immunol 2005;115:1049–1055.SchatzM]]MosenD]]ApterAJ&etal;Relationships among quality of life, severity, and control measure in asthma: an evaluation using factor analysis.J Allergy Clin Immunol20051151049-105517. Stempel DA, Roberts CS, Stanford RH. Treatment patterns in the months prior to and after asthma-related emergency department visit. Chest 2004;126:75–80.StempelDA]]RobertsCS]]StanfordRHTreatment patterns in the months prior to and after asthma-related emergency department visit.Chest200412675-8018. Fuhlbrigge AL, Kitch BT, Paltiel AD, et al. FEV (1) is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol 2001;107:61–67.FuhlbriggeAL]]KitchBT]]PaltielAD&etal;FEV (1) is associated with risk of asthma attacks in a pediatric population.J Allergy Clin Immunol200110761-6719. Fuhlbrigge AL, Weiss ST, Kuntz KM, et al. Forced expiratory volume in 1 second percentage improves the classification of severity among children with asthma. Pediatrics 2006;118:e347–e355.FuhlbriggeAL]]WeissST]]KuntzKM&etal;Forced expiratory volume in 1 second percentage improves the classification of severity among children with asthma.Pediatrics2006118e347-e35520. Butler J, Arbogast PG, Daugherty J, et al. Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge. J Am Coll Cardiol 2004;43:2036–2043.ButlerJ]]ArbogastPG]]DaughertyJ&etal;Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge.J Am Coll Cardiol2004432036-2043
