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A quality improvement study using fishbone analysis and an electronic medical records intervention to improve care

Jonathan Gold1, David Reyes-Gastelum, Jane Turner

  • 11Michigan State University College of Human Medicine, East Lansing, MI.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|April 12, 2013
PubMed

Insights

Improving pediatric asthma care requires addressing guideline gaps. A quality improvement project using the plan-do-check-act (PDCA) framework and electronic medical record (EMR) tools successfully enhanced asthma action plan and medication counseling documentation.

Area of Science:

  • Pediatric primary care
  • Quality improvement science
  • Asthma management

Background:

  • Gaps persist in adhering to national asthma prevention guidelines for children.
  • Pediatric primary care settings face challenges in delivering consistent asthma care.
  • Improving quality of care is crucial for managing childhood asthma effectively.

Purpose of the Study:

  • Identify barriers to asthma guideline compliance in a pediatric clinic.
  • Develop and implement interventions to improve asthma care quality.
  • Evaluate the impact of interventions on guideline adherence.

Main Methods:

  • Utilized the plan-do-check-act (PDCA) framework and fishbone analysis.
  • Implemented two interventions integrated within the electronic medical record (EMR).
  • Analyzed physician documentation of asthma quality measures over 16 months.

Main Results:

  • Significant improvement in asthma action plan documentation (P < .001).
  • Substantial increase in medication counseling documentation (P < .001).
  • Improvements observed across core and noncore patient groups.

Conclusions:

  • A systematic quality improvement approach enhances pediatric asthma care.
  • EMR integration is effective for implementing and monitoring asthma care interventions.
  • PDCA and fishbone analysis effectively identify barriers and solutions for guideline adherence.

Keywords:
PDCAasthmaelectronic health recordsfishbone analysispediatricquality improvement

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