Assistant Professor University of Utah School of Medicine SALT LAKE CITY, Utah, United States
Background: There are about 4.7 million children with asthma in the United States. The National Asthma Education and Prevention Program (NAEPP) published updated asthma diagnosis and management guidelines which recommend assessing asthma control and providing an asthma action plan (AAP). Guideline adherence varies depending on provider knowledge and practice capability. Objective: To improve asthma control using a standardized tool (Childhood Asthma Control Test [CACT] in 4-11 year old, or Asthma Control Test [ACT] in 12-18 year old) and increase the use of AAP for all patients with asthma. Design/Methods: In collaboration with the Utah Department of Health Asthma Program and the Departments of Pulmonary Medicine and Allergy/Immunology, a pediatric academic outpatient clinic (intervention clinic) participated in a quality improvement (QI) project starting in November 2019. The clinic created an asthma team who joined with a QI specialist to improve CACT/ACT and AAP completion in patients at well child and acute visits with asthma as an active diagnosis. Monthly asthma education webinars and QI coaching were provided. Interventions included: 1) medical support staff education to provide CACT/ACT via electronic health record (EHR) prior to visit and ensuring completion during rooming, 2) provider education to give AAP through the EHR. Monthly reports showing rates of CACT/ACT and AAP completion were generated and utilized to discuss goal progress. These rates were compared using run charts to 32 clinics that did not participate in the QI project (comparison clinics) and analyzed using binomial distribution. Results: From November 2019 through July 2023, CACT/ACT and AAP were completed in 46% and 33% of visits at the intervention clinic (N=346) respectively, compared to 7% and 14% at the comparison clinics (N=5,721). Rates of ACT and AAP completion were significantly higher in the intervention clinic compared to comparison clinics (p < 0.01).
Conclusion(s): Implementing a standard process to assess asthma control, and providing AAP are basic quality practices per asthma clinical guidelines. Despite well-known evidence and best practice guidelines, quality of asthma care remains a problem. Participating in the QI project, and resulting practice facilitation, was associated with increased rates of CACT/ACT and AAP completion in pediatric patients with asthma. Busy physicians and clinical care teams may be more successful at implementing changes in asthma care through use of practice facilitation.
