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A systematic review of the implementation and impact of asthma protocols
Judith W Dexheimer1, Elizabeth M Borycki, Kou-Wei Chiu
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, MLC 2008, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. Judith.dexheimer@cchmc.org.
Insights
Implementing asthma guidelines, particularly paper-based reminders, is common and improves pediatric asthma care. Computerized methods are increasing, but all approaches enhance patient outcomes and practitioner performance.
Area of Science:
- Pediatric Pulmonology
- Healthcare Management
- Clinical Informatics
Background:
- Childhood asthma is a prevalent illness requiring effective management strategies.
- Guideline implementation is crucial for improving patient outcomes in asthma care.
- Various reminder systems exist to integrate asthma guidelines into clinical workflows.
Purpose of the Study:
- Identify the most common methods for implementing asthma guidelines.
- Determine which implementation methods significantly enhance clinical asthma care.
- Recognize factors associated with successful and sustainable guideline implementation.
Main Methods:
- Systematic review of studies evaluating asthma protocols and reminder interventions.
- Inclusion criteria focused on human subjects, protocol evaluation, and clinical trials.
- Databases searched included PubMed, CINAHL, Web of Science, and EMBASE.
Main Results:
- 101 full-text articles were analyzed from 14,478 abstracts.
- Paper-based reminders were the most frequent implementation method, followed by computerized systems.
- No studies reported negative impacts on healthcare practitioner performance or patient outcomes.
Conclusions:
- Paper-based implementations remain the most popular for asthma guidelines.
- There is a growing trend in publications on asthma protocol reminder systems, including digital approaches.
- Asthma guidelines, irrespective of the implementation method, generally lead to improved patient care and practitioner performance.
Background:
Asthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow. Our goal is to determine the most prevalent method of guideline implementation; establish which methods significantly improved clinical care; and identify the factors most commonly associated with a successful and sustainable implementation.
Methods:
PUBMED (MEDLINE), OVID CINAHL, ISI Web of Science, and EMBASE.
Study Selection:
Studies were included if they evaluated an asthma protocol or prompt, evaluated an intervention, a clinical trial of a protocol implementation, and qualitative studies as part of a protocol intervention. Studies were excluded if they had non-human subjects, were studies on efficacy and effectiveness of drugs, did not include an evaluation component, studied an educational intervention only, or were a case report, survey, editorial, letter to the editor.
Results:
From 14,478 abstracts, we included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay.
Conclusions:
Paper-based implementations are by far the most popular approach to implement a guideline or protocol. The number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method.
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