Resident Physician Northwell Health, Staten Island University Hospital Staten Island University Hospital Brooklyn, New York, United States
Background: Per CDC 2018 data, 6.2 mil children in the US <18 yrs have a dx of asthma. NYS has higher ED visits in all age groups, with significant public health & financial ramifications. Many children presenting to the ED are not followed by pulmonology & are managed by general pediatricians. Therefore, classification of asthma in the outpatient setting & appropriate prescription of anti-inflammatory meds is necessary to improve asthma outcomes.
Objective: To improve the quality of asthma care & asthma related health outcomes for children seen in the outpatient clinic. Our goals were to: increase documentation of asthma classification using NAEP Guidelines & prescribe appropriate anti-inflammatory meds to improve control.
Design/Methods: Pts with a dx of asthma 0-18 yrs who presented to the clinic for any visit were included. Providers included 4 pediatricians, 24 residents & 1 adolescent physician. Retrospective chart review of pts seen in Sept 2019 served as baseline data. Chart reviews continued Oct 2019-March 2020. 252 charts were reviewed total; 59 pre-intervention, 193 post-intervention. PDSA cycle interventions included the intro & use of an EMR macro & provider education. The macro prompted physicians to document asthma care: classification of asthma severity, appropriate prescription of anti-inflammatory medication, provision of an asthma action plan (AAP), completion of a medication administration form (MAF) & if the pt was appropriately referred to pulmonology &/or social services.
Results: Baseline data revealed 42% of pts had documented asthma severity, 34% were prescribed an ICS, 15% had AAPs, 15% had MAFs & 54% were referred to pulm. After the 2nd PDSA cycle, asthma classification increased to 86% in Jan. By March, providers used the macro for 67% of visits resulting in a 96% asthma classification rate, 67% of pts with appropriately prescribed anti-inflammatory, 81% with AAPs, 70% with MAFs & 78% referred to pulm (Figure 1). Post-intervention data revealed a highly statistically significant increase in asthma classification (p value <0.0001) (Table 1). Conclusion(s): Through the use of an EMR macro, education, monthly data analyzation & PDSA cycle reviews, there has been a dramatic increase in asthma classification in the outpatient setting. Classification has resulted in prescription of appropriate anti-inflammatory meds 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 asthma with improved outcomes data.
Authors/Institutions: Gina M. Auricchio, Staten Island University Hospital, Brooklyn, New York, United States; Emily Robbins, Staten Island University Hospital, Brooklyn, New York, United States; Steven Daoud, Staten Island University Hospital, Brooklyn, New York, United States; Pushpom James, Staten Island University Hospital, Brooklyn, New York, United States; Anna Cornish, Staten Island University Hospital, Brooklyn, New York, United States; April Lee, Staten Island University Hospital, Brooklyn, New York, United States; Shadwa Hassan, Staten Island University Hospital, Brooklyn, New York, United States; Matthew Weeks, Staten Island University Hospital, Brooklyn, New York, United States
