A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits

Area of Science:

• Pediatric healthcare quality improvement
• Public health interventions
• Asthma management

Background:

• Asthma exacerbations frequently lead to emergency department (ED) visits, particularly in children covered by Medicaid.
• A quality improvement project was initiated in 2010 to enhance pediatric asthma care within a predominantly Medicaid-eligible primary care network.
• The project aimed to decrease asthma-related ED visits in children aged 2-18 by 3% annually.

Purpose of the Study:

• To reduce asthma-related emergency department (ED) utilization in a large, high-risk pediatric population.
• To implement and sustain a multicomponent quality improvement initiative for pediatric asthma care.
• To evaluate the effectiveness of sequential interventions in a primary care setting.

Main Methods:

• A multisite, urban, high-risk primary care network affiliated with a children's hospital served as the setting.
• Five sequential interventions were implemented: increased use of asthma action plans, primary care-based Asthma Specialty Clinic visits, standardized asthma notes, Asthma Control Test documentation, and timely step-up therapy.
• Data were collected from 2010 to 2019.

Main Results:

• Asthma-related ED visits decreased from 21.7 to 14.5 per 1000 patients annually, a 33% reduction.
• The project achieved and sustained goal metrics for 4 out of 5 key interventions.
• Significant reductions in ED utilization were observed over the study period.

Conclusions:

• The implemented quality improvement project successfully reduced emergency department utilization for asthma in a large, high-risk pediatric population.
• Sustainable positive outcomes in asthma care can be achieved through a multicomponent, longitudinal approach in primary care networks.
• The findings highlight the potential for quality improvement initiatives to impact public health outcomes in vulnerable populations.