Resident The Children's Hospital at Montefiore Bronx, New York, United States
Background: Asthma is the most common pediatric chronic respiratory disorder and is a leading cause of ED visits and hospitalizations in children. In 2020, the NHLBI released new Asthma Management Guidelines including Single Maintenance and Reliever Therapy (SMART) to reduce the frequency and severity of asthma exacerbations. Objective: This QI project aims to increase the percent of patients discharged with the correct asthma controller medication per the 2020 Asthma Management Guidelines by 30% over 12 months. Design/Methods: This QI study takes place at our academic, quaternary care, urban children’s hospital. Our interprofessional QI team consists of physicians, pharmacists, and nurses. Classic QI tools (key driver diagrams, process maps, and fishbone diagrams) were used to plan targeted PDSA cycles. Provider education sessions, updates to our institution’s existing asthma clinical pathway, and creation of a novel, interactive provider-focused website are included in our targeted intervention bundle. Baseline data was collected 5/2023-7/2023; the median percent of correct asthma controller discharge medication was 43%. All patients aged 4-18 years admitted with a primary diagnosis of asthma will be included; patients discharged from the PICU will be excluded. The primary outcome is the proportion of patients discharged on appropriate controller medication. Process measures include the percent of providers participating in our didactic sessions and the percent of patients who are able to obtain the prescribed controller medication. Intervention data will be collected beginning 10/2023 and will be graphed on a run chart. Nelson’s rules will be applied to determine special cause variation. In addition to chart review, we plan to call five randomly selected families 2-4 weeks post-discharge to address understanding of new medications and discuss any barriers obtaining medications to further inform iterative PDSA cycles, as necessary. At this time, we are just beginning post-intervention data collection and we plan to share our results at the PAS 2024 Meeting.
