Improving asthma care in a pediatric resident clinic

Abstract

There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual and guideline-consistent asthma care in resident clinics. Practice improvement modules aimed at improving resident physician adherence to asthma care guidelines have not been consistently utilized and have not yet been studied.Our aim was to increase guideline consistent care in our pediatric resident clinic in a twelve-month period via increasing performance on the following measures to 75%: spirometry testing; influenza immunization recommendation; level of control assessed through the use of a standardized questionnaire; appropriate medications per national guideline; and use of written asthma action plans.A summarized pediatric-specific version of the National Heart Lung and Blood Institute National Asthma Education and Prevention Program Expert Panel Report 3 (NHLBI EPR-3) guidelines was made readily available to increase provider education. Electronic health record (EHR) enhancements included adding templates to create standardized asthma action plan, asthma control test and a pediatric asthma controller medication order-set. We also addressed the education of patients by simplifying patient instructions. We monitored our progress through the use of an online practice improvement module.We found statistically significant increases in use of a standardized instrument to determine level of control (20% to 81%); recommendation of influenza immunization (56% to 97%); use of national medication treatment guidelines (28% to 98%); distribution of asthma action plans (29% to 65%); and provision of asthma self-management education (35% to 74%).Standardizing the implementation of national guidelines for pediatric asthma through the use of a practice improvement module and electronic health records improved adherence to guidelines. The module allowed us to identify goals for improvement, collect and analyze our group performance data over time, assess the impact of each change, and redesign our process. Improving adherence to national pediatric asthma care guidelines is especially important in settings such as resident teaching clinics which provide care to underserved populations at higher risk for complications related to asthma.

User Experience Design for Adoption of Asthma Clinical Decision Support Tools

“…9,20, 26,47 Readily accessible EHR tools at the point of care were favored. 12,14,20 -22,35,37,38,51 Standardized asthma guideline-based tools were seen as a facilitator to routinely capture relevant information 22,26,35,40,52 and educate. 26,32,35 Barriers to adoption included technology limitations, 9,14,21,42,43,53 incompatible operating systems, inappropriate practice software, manual data entry, or extra steps.…”

“…12,14,20 -22,35,37,38,51 Standardized asthma guideline-based tools were seen as a facilitator to routinely capture relevant information 22,26,35,40,52 and educate. 26,32,35 Barriers to adoption included technology limitations, 9,14,21,42,43,53 incompatible operating systems, inappropriate practice software, manual data entry, or extra steps. 9,12,14,20 -22,26,28,29,32-36,38,39,46,49,52 Suboptimal graphical user interfaces (e.g., placement of buttons, alerts) also dampened enthusiasm.…”

“…Twenty CDS systems were integrated with the electronic health record (EHR). 10,12,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] All but three studies were informed by guidelines, 14,21,44 and 18 used the…”

“…• If negative attitude toward the tool, unlikely to be adopted 22,[28][29][30][31]33,35,36,[38][39][40][41][45][46][47][48][49][50] Twenty-seven studies were with general practitioners, 9,10,12,14,26-29,31-43,45,46,49-52 four included subspecialists, 21,22,30,48 and four included both. 20,44,47,53 Common tool functionalities included determination of asthma control status, recommendation of medications, automatic note generation for EHR, and creation of an asthma action plan.…”

Adolescent ownership of asthma health: A concept analysis

“…The inhaler technique checklists would allow for both self‐efficacy, as well as mastery of asthma self‐care. Asthma action plans also provide a written plan of care that can be followed by the adolescent, school, and health care team . Having an asthma care pathway in written form would also allow for ownership of health, the family has a consistent plan to follow while at home.…”