Electronic Health Record (EHR) Quality Tools Improved and Sustained Use of Asthma Action Plans for 3 years in a Primary Care Pediatric System

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.121-121
• Main Authors: Pletta, Karen, Moreno, Megan, Allen, Gail S., Sleeth, Jeffrey, Jain, Sanjeev, Kerr, Bradley
• Format: Article
• Language: English
• Subjects: Asthma; Children; Disease management; Electronic medical records; Emergency medical care; Emergency medical services; Pediatrics; Primary care; Quality control
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA2.121

Background: 6 million US children have asthma resulting in 800,000 asthma-emergency room visits per year. Asthma Action Plans are recommended for patients to improve asthma control but are not consistently utilized in busy pediatric primary care clinics. Specific Aim: The specific aim of this project was to develop EHR quality tools to increase the use of written Asthma Action Plans (wAAP) to pediatric patients to improve asthma control and reduce asthma-related ER visits. Design/Methods: Our primary care pediatric system includes 8 clinics with 37 pediatricians serving 46,000 patients approximately 10% with asthma. Plan-Do-Check-Act quality improvement methods including fishbone diagrams and A3s were used to develop EHR pediatric asthma registries and team-based tools including well-child visit and outreach workflows. Pediatricians updated registry lists to include patients with asthma. At well-child visits, patients completed Asthma Control Tests (ACTs) and received wAAPs. An EHR Registry workbench was developed to track ACTs, wAAPs, flu shots and asthma-ER visits. Staff made outreach calls to patients overdue for ACTs; providers used these to complete and send wAAPs to patients. Providers received monthly registry reports with ACTs, wAAPs and asthma-ER visits to show progress and encourage continued involvement. Additional interventions included further A3s, streamlining workflows and contacting individual providers/clinics. Goal rate for wAAP was 72%. Quality incentive payments were given for provider achievement of this rate. Rates of wAAP and asthma-ER use were evaluated at baseline (5/1/2015), 1 year (T1), 2 years (T2) and 3 years (T3). We used McNemar's Chi-squared test for proportions. Results: Total number of patients in the pediatric asthma patient registry was 4392 at baseline, 3423 at T1, 3298 at T2 and 3249 at T3. The number of patients with wAAP was 667 (15%) at baseline, 1587 (46%) at T1 (p