Related Experiment Video
Updated: Jul 11, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits
Stephen J Hersey1, Jessica Retzke1, Elizabeth D Allen2
1Division of Primary Care Pediatrics.
Insights
A quality improvement project reduced emergency department visits for pediatric asthma by 33% in a high-risk Medicaid population. This demonstrates sustainable improvements in asthma care within primary care networks.
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.
Background And Objectives:
Asthma exacerbation is a common and often preventable cause of Emergency Department (ED) utilization. Children eligible for Medicaid are at increased risk of poor asthma control and subsequent ED visits. In 2010, we implemented a multicomponent longitudinal quality improvement project to improve pediatric asthma care for our primary care population, which was 90% Medicaid-eligible. Our goal was to reduce asthma-related ED visits by patients ages 2 to 18 years by 3% annually.
Methods:
The setting was a multisite large urban high-risk primary care network affiliated with a children's hospital. We implemented 5 sequential interventions within our network of pediatric primary care centers to increase: use of asthma action plans by clinicians, primary care-based Asthma Specialty Clinic visits (extended asthma visits in the main primary care site), use of a standard asthma note at all visits, documentation of the Asthma Control Test, and step-up therapy for children with poorly controlled asthma.
Results:
At baseline in 2010, there were 21.7 asthma-related ED visits per 1000 patients per year. By 2019, asthma-related ED visits decreased to 14.5 per 1000 patients per year, a 33% decrease, with 2 center line shifts over time. We achieved and sustained our goal metrics for 4 of 5 key interventions.
Conclusions:
We reduced ED utilization for asthma in a large, high-risk pediatric population. The interventions implemented and used over time in this project demonstrate that sustainable outcomes can be achieved in a large network of primary care clinics.
Related Concept Videos
01:30Asthma-IV: Nursing Management
First, in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:29Asthma-I: Introduction
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...