Implementation of an Electronic Asthma Action Plan at a Pediatric Office

Abstract

Problem: Despite being the most common pediatric chronic disease, asthma continues to be a leading cause of primary care office visits each year. A small, pediatric primary care office in Maryland reported 133 preventable asthma related clinic visits between 2021 and 2023, resulting in overbooking of appointments, reduced availability for non-asthma-related visits, and provider and clinic stress. Asthma guidelines recommend use of an Asthma Action Plan (AAP), however, 0% patients at this clinic have one despite seeing at least 5 patients per week with asthma. AAP use is associated with reduced asthma exacerbations/complications and decreased outpatient visits related to asthma. Purpose: The purpose of this quality improvement initiative is to increase utilization of an AAP through integration into the electronic medical record (EMR) for all patients with asthma. Methods: The implementation team, consisting of a project leader, 3 providers, an office manager, and 5 medical assistants, were educated on the data collection tools and the AAP reviewal protocol. An individualized electronic AAP was integrated into the EMR of every asthma patient. Providers reviewed and updated the AAP while providing patient/caregiver education during appointments. Weekly chart audits were completed to collect data on type of visit (scheduled or unscheduled), reason for seeking care, provider acknowledgement of reviewing AAP, and provision of AAP to patient/guardian. Data from these tools was collected in a private location at the practice and entered in REDCap by the project lead. Ongoing strategies for success included reminders to staff of project procedures, frequent audits to assess for compliance, and continued identification of barriers and facilitators. Results: All staff have completed education training on procedures of the QI project. During the 16-week period, 53.1% of asthma patients seen had an Asthma Action plan embedded into their EMR. The AAP was reviewed and updated only 50% of the time for patients with asthma. There was an increase in self-manageable asthma sick visits at 1.92 per week Only 13.3 % of patients received a printed copy of the AAP on discharge. Conclusions: AAP integration into the EHR increased provider and patient discussions of independent asthma management but did not improve the number of self-manageable asthma visits at the practice.