Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System

Kuhn, Lindsay; Reeves, Kelly; Taylor, Yhenneko J.; Tapp, Hazel; McWilliams, Andrew; Gunter, Andrew; Cleveland, Jeffrey A.; Dulin, Michael

doi:10.3122/jabfm.2015.03.140248

Cited by 52 publications

(47 citation statements)

References 34 publications

(28 reference statements)

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“…We have demonstrated a sustained improvement in the provision of AAPs from 17.9% in 2007 to 71.9% overall, and 85.9% for those discharged with a diagnosis of asthma in 2014–2015. These results are consistent with the use of eAAPs that have been described in other studies and, as well as improved documented provision of an AAP, evaluations have shown an association between eAAP receipt and significant reductions in paediatric asthma exacerbations, including 33% lower odds of requiring oral steroids ( P < 0.001), compared with controls . In addition, the electronic sharing of the AAP has the potential to increase efficiency and enhance effective communication among health‐care providers, families and schools .…”

Section: Discussionsupporting

confidence: 89%

Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre‐school wheeze action plans

O’Leary

Pegiazoglou

Marshall

et al. 2016

J Paediatrics Child Health

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Aim:To measure the long-term improvement in the documented provision of an asthma action plan (AAP) to children with asthma and wheeze discharged from the Emergency Department following the introduction of the electronic AAP (eAAP) and to determine the need for an electronic pre-school wheeze action plan in our population. Methods: A retrospective case note review, from July 2014 to June 2015, of all patients over 12 months old discharged from the Emergency Department or Emergency Medical Unit, with a discharge diagnosis of either asthma or wheeze. The primary outcome was the documentation of an AAP, either recorded electronically as an eAAP or a report of an AAP as part of the patient medical record. Results: Two thousand three hundred and forty-two patients were included in the study, 926 with asthma and 1416 with wheeze. The median age was 3.3 years (interquartile range (IQR) 3.5, range 1-15.9 years). The median age of the children with asthma was 5.3 years (IQR 4.6) and of the children with wheeze was 2.5 years (IQR 2.0).Overall, 1683 (71.9%) children had a documented AAP, with a significant difference between those with a discharge diagnosis of asthma (85.9%) compared with wheeze (62.9%), P < 0.001. These results justified the design of the electronic pre-school wheeze action plan. Conclusions:The integration of an eAAP into the Emergency Department has resulted in a sustained improvement in the documented provision of an AAP to children with a discharge diagnosis of asthma. Children with a discharge diagnosis of wheeze are significantly less likely to receive an action plan.

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Section: Discussionsupporting

confidence: 89%

Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre‐school wheeze action plans

O’Leary

Pegiazoglou

Marshall

et al. 2016

J Paediatrics Child Health

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“…School nurse involvement in asthma care coordination has resulted in improvements in health care use, school attendance, medication adherence, and quality of life. 3,4,6,7 School nurses are uniquely positioned to provide direct care, adherence counseling, and education for asthmatic patients. 8 They can review and reinforce proper inhaler technique and usually have the most recorded data of quick-relief medication use—one of the hallmarks of asthma control.…”

Section: Componentmentioning

confidence: 99%

Creation and implementation of SAMPRO™: A school-based asthma management program

Lemanske

Kakumanu

Shanovich

et al. 2016

Journal of Allergy and Clinical Immunology

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Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.

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“…[71] The breadth of computerized decision support efforts to date in the EHR is beyond scope for this review, but it is important to highlight efforts in the domain of pediatric asthma. Prior asthma-related CDS includes aids for diagnosis of clinical deterioration through patient electronic self-report,[72] providing evidence based guidelines on asthma action plans at point of care,[73, 74] and asthma self-management applications built for mobile devices. [75] A Cochrane review of the latter category in 2013 demonstrated insufficient evidence regarding integration of mobile device-enabled asthma self-management applications into the clinical workflow.…”

Section: The Role Of Prediction Rules In Clinical Decision-supportmentioning

confidence: 99%

The asthma prediction rule to decrease hospitalizations for children with asthma

Arnold

Sills

Walsh

2016

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review The aim of the present review was to discuss the challenges around clinical decision-making for hospitalization of children with acute asthma exacerbations and the development, internal validation and future potential of the Asthma Prediction Rule (APR) to provide meaningful clinical decision-support that might decrease unnecessary hospitalizations. Recent findings The APR was developed and internally validated using predictor variables available before treatment in the ED, and performed well to predict need-for-hospitalization. Oxygen saturation on room air and expiratory phase prolongation were most strongly associated with need-for-hospitalization. Summary Research on prediction rules in pediatric asthma is rare. We developed and internally validated the APR using clinically intuitive predictor variables that are available at the bedside. Before incorporation in to electronic decision-support the APR must undergo external validation and an impact analysis to determine if use of this tool will change clinician behavior and improve patient outcomes.

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Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System

Cited by 52 publications

References 34 publications

Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre‐school wheeze action plans

Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre‐school wheeze action plans

Creation and implementation of SAMPRO™: A school-based asthma management program

The asthma prediction rule to decrease hospitalizations for children with asthma

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