Improving asthma care in a pediatric resident clinic

Area of Science:

• Pediatric Pulmonology
• Healthcare Quality Improvement
• Clinical Practice Guidelines

Background:

• Pediatric asthma management varies in outpatient settings, with a notable gap between usual care and national guideline adherence in resident clinics.
• Practice improvement modules for asthma guideline adherence are underutilized and unstudied.
• Resident clinics often serve underserved populations at higher risk for asthma-related complications.

Purpose of the Study:

• To increase guideline-consistent pediatric asthma care in a resident clinic over twelve months.
• To achieve 75% performance on key asthma management measures: spirometry, influenza immunization, control assessment, appropriate medications, and asthma action plans.

Main Methods:

• A pediatric-specific summary of NHLBI EPR-3 asthma guidelines was disseminated.
• Electronic health record (EHR) enhancements included standardized templates for action plans, control tests, and medication orders.
• An online practice improvement module tracked progress and facilitated process redesign.
• Patient education materials were simplified.

Main Results:

• Significant increases were observed in: standardized control assessment (20% to 81%), influenza immunization recommendation (56% to 97%), guideline-based medication use (28% to 98%), asthma action plan distribution (29% to 65%), and self-management education (35% to 74%).

Conclusions:

• Standardizing pediatric asthma guideline implementation via practice improvement modules and EHRs demonstrably improved adherence.
• This systematic approach enabled goal identification, data analysis, and process redesign for continuous quality improvement.
• Enhanced adherence to national pediatric asthma guidelines is crucial, particularly in resident teaching clinics serving high-risk, underserved populations.