BACKGROUND: Per CDC 2018 data, 6.2 million children in the US under the age of 18 have a diagnosis of asthma (1). Reviewing national statistics, NYS has higher ED visits in all age groups (2), with significant public health & financial ramifications. Many children presenting to the ED are not followed by pulmonology & are managed by their general pediatricians. Therefore, classification of asthma severity in the pediatric outpatient setting along with appropriate prescription of anti-inflammatory medications is necessary to improve asthma outcomes.
OBJECTIVE: To improve the quality of asthma care & asthma related health outcomes for children seen at the outpatient clinic at SIUH. Our goals were to: increase documentation of asthma classification using the National Asthma Education & Prevention Guidelines for the Diagnosis & Management of Asthma (3) & thereby prescribe appropriate anti-inflammatory medications to improve control.
DESIGN: Patients with a diagnosis of asthma aged 0-18 yrs who presented to the outpatient clinic for any visit type were included. Outpatient participating providers included 4 pediatricians, 24 residents & 1 adolescent physician. Retrospective chart review of asthmatic patients seen in Sept 2019 served as baseline data. Chart reviews continued from Oct 2019-March 2020. 252 charts were reviewed total; 59 pre-intervention, 193 post-intervention. PDSA cycle interventions included the introduction & use of an EMR macro & provider education. The EMR macro prompted physicians to document asthma care: classification of asthma severity, appropriate prescription of anti-inflammatory medication, provision of an asthma action plan (AAP) to family, completion of a medication administration form (MAF) & if the patient was appropriately referred to pulmonology &/or social services.
RESULTS: Baseline data revealed 42% of patients had documented asthma severity, 34% were prescribed an ICS, 15% had AAPs, 15% had MAFs & 54% were referred to pulmonology. After the 2nd PDSA intervention, asthma classification increased to 86% in January. By March, providers used the macro for 67% of visits, resulting in a 96% asthma severity classification rate, 67% of patients with appropriately prescribed anti-inflammatory, 81% with completed AAPs, 70% with completed MAFs & 78% referred to pulmonology (Figure 1). In total, post-intervention data revealed a highly statistically significant increase in asthma classification (p value <0.0001) (Table 1).
CONCLUSION: Through the use of an EMR macro, extensive educational efforts, monthly data analyzation & PDSA cycle reviews, there has been a dramatic increase in asthma severity classification in the outpatient setting. Classification has resulted in prescription of appropriate anti-inflammatory medications with reduction in ED visits. We hypothesize that the use of the macro for all outpatient asthmatic visits will lead to better quality of care for children with bronchial asthma with improved outcomes data.
