267 - Improving asthma care in concordance with the 2020 NHLBI clinical practice guidelines using a telemedicine model of care delivery during a global pandemic

Poster Board #: 267
Publication #: 3900-HP-QA.267

Background: Asthma is a common chronic health condition in children with potential for serious morbidity. In the setting of the global pandemic, an innovative approach is required to manage children with asthma without increasing their exposure to health care settings. In addition, new guidelines for the care of asthma were released by the NHLBI in 2020, necessitating adjustments to clinical care.


Objective: Using quality improvement methodology, we sought to improve asthma care in a pediatric primary care clinic by using a telehealth model for asthma visits and use of a clinical algorithm based on the 2020 NHLBI guidelines. Primary aims were to increase the number of patients with correctly classified asthma diagnoses and to improve rates of controller therapy for patients with persistent asthma.


Design/Methods: We implemented multiple PDSA cycles aimed at the above goals. We developed an asthma classification and treatment algorithm based on the 2020 NHLBI guidelines to inform our clinical care. We reviewed charts to improve the asthma classification of patients, we called patients overdue for asthma care and we conducted telemedicine asthma visits. We continue to adjust supports within the electronic medical record. Next steps will include expanding education on new NHLBI guidelines to providers and staff and continuing outreach and education efforts with families. Outcomes were assessed using successive statistical process control charts and the Schewart rules to determine statistical significance.


Results: Of all patients in clinic with asthma or an albuterol prescription, we increased correct classification from 76.9% to 99.0%. We increased the percentage of patient with persistent asthma with active controller medication prescriptions from 46.7% to 72.7%. These improvements were statistically significant.

Conclusion(s): Our multifaceted quality efforts improved the treatment of patients with asthma incorporating a telehealth model of care delivery. To our knowledge, we are one of the first groups to implement the latest asthma guidelines into a sustainable workflow at a resident-based pediatric primary care clinic. This project can serve as a model for implementation of the NHLBI guidelines in the primary care setting as well as a model for the novel use of telemedicine as a modality for improving asthma control and management. In future work, we hope to also evaluate primary patient outcomes including emergency room visits and hospital stays.


Figure 1: A statistical process control chart plotting the percentage over time of patients with an asthma diagnosis specifying severity in their problem list compared to total patients on the asthma registry. Quality interventions started in September 2020 with three subsequent significant data points using Shewhart rules for significance.


Figure 2: A statistical process control chart plotting the percentage over time of clinic patients on the asthma registry who have an active controller medication prescription. Asthma registry patients have a diagnosis of asthma and/or a prescription for albuterol. Quality interventions started in September 2020 with three subsequent significant data points using Shewhart rules for significance.

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Authors/Institutions: Ejiofor Ezekwe, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States; Elizabeth M. Walters, University of North Carolina, Durham, North Carolina, United States; Alexandra Lorentsen, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States; Lauren Wittwer, University of North Carolina, Durham, North Carolina, United States; Isabelle Dagher, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States; Katherine Jordan, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States