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Improving Asthma Action Plan Completion Rates across Five Divisions in an Academic Children's Hospital
Maria G Alfieri1, Katie Catalano1, Tregony Simoneau2
1From the Department of Pediatrics, Boston Children's Hospital, Boston, Mass.
Insights
A quality improvement project successfully increased the completion rate of Asthma Action Plans (AAPs) for pediatric asthma patients from 80% to 87% using a cross-divisional competition. This initiative improved patient self-management and provider processes.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Chronic Disease Management
Background:
- Childhood asthma is a prevalent chronic condition requiring regular management.
- Asthma Action Plans (AAPs) are crucial for personalized asthma self-management and necessitate annual updates.
- Healthcare providers encounter challenges in consistently completing AAPs for pediatric asthma patients.
Purpose of the Study:
- To enhance the percentage of pediatric patients with up-to-date Asthma Action Plans (AAPs) from 80% to 85% within a five-division healthcare system.
- To implement and evaluate a quality improvement initiative focused on improving AAP completion rates.
Main Methods:
- A quality improvement project utilized the Model for Improvement framework.
- A cross-divisional competition among five hospital divisions (Adolescent/Young Adult Medicine, Allergy, Pulmonary, two Primary Care) was implemented from June to October 2021.
- Plan-Do-Study-Act cycles and monthly Learning Sessions facilitated intervention trials and collaboration.
Main Results:
- Statistical process control analysis showed an increase in the overall AAP completion rate from a baseline of 80% to 87%.
- All participating divisions demonstrated improved AAP completion rates during the intervention period.
- Variability in the sustainment of improved completion rates was observed across divisions.
Conclusions:
- A cross-divisional competition effectively motivated healthcare divisions to enhance processes for increasing AAP completion rates.
- This competitive quality improvement approach fostered engagement and idea sharing, leading to improved performance.
- The competition model may be applicable to other quality improvement initiatives in healthcare.
Introduction:
Asthma is the most common chronic disease among children. Asthma Action Plans (AAPs) enable asthma self-management tailored to each patient and should be updated annually. At our institution, providers face challenges in creating reliable processes to consistently complete AAPs for patients with asthma. This project's aim was to increase the percentage of patients across five hospital divisions who have an up-to-date AAP from 80% in May 2021 to 85% by October 1, 2021.
Methods:
We launched a quality improvement (QI) project using the Model for Improvement, focusing on improving AAP completion rates across five hospital divisions providing ambulatory care for asthma patients. The divisions (Adolescent/Young Adult Medicine, Allergy, Pulmonary, and two Primary Care sites) participated in the QI process using tools to understand the problem context. They implemented a cross-divisional AAP completion competition from June to October 2021. Each month during Action Periods, divisions trialed their interventions using Plan-Do-Study-Act cycles. We held monthly Learning Sessions for divisions to collaborate on successful intervention strategies.
Results:
Statistical process control chart analysis demonstrated that the overall AAP completion rate increased from a baseline of 80% to 87% with the initiation of the competition. All divisions showed improvement in AAP completion rates during the active intervention period, but sustainment varied.
Conclusions:
The cross-divisional competition motivated five divisions to improve processes to increase AAP completion rates. This approach effectively fostered engagement and idea sharing to boost performance, and may be considered for other QI projects.
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