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Improving Asthma Guideline Implementation in Hospital Medicine (ImAGINE): A Single-site Improvement Initiative
Daniel Herchline1,2, Michelle Mitchell1, Shanon Brannen1
1From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
This study improved adherence to the Global Initiative for Asthma (GINA) guidelines for pediatric asthma exacerbations. Interventions increased guideline-concordant controller regimens from 39% to 71% in patients aged 6-18.
Area of Science:
- Pediatric Pulmonology
- Quality Improvement Science
- Evidence-Based Medicine
Background:
- The 2019 Global Initiative for Asthma (GINA) report recommended updated approaches for pediatric asthma management.
- Asthma exacerbations in children require effective controller regimens to reduce morbidity and improve symptom control.
- Baseline adherence to GINA guideline-concordant controller regimens for pediatric asthma exacerbations was suboptimal at 39%.
Purpose of the Study:
- To increase the percentage of pediatric patients (6-18 years) with asthma exacerbations receiving GINA guideline-concordant controller regimens.
- To improve asthma management by implementing changes based on the 2019 GINA report recommendations.
- To achieve a target concordance rate of 50% within six months.
Main Methods:
- Utilized the Model for Improvement framework with stakeholder input to identify key drivers.
- Implemented interventions including education on GINA guidelines, audit and feedback for prescribers, standardized electronic health record documentation, and improved access to decision-support tools.
- Employed electronic health record queries for patient identification and control charts for weekly data tracking.
Main Results:
- The average baseline concordance rate for GINA guideline-concordant controller regimens was 39% with significant variability.
- Following the implementation of interventions, a notable shift in the centerline of control charts was observed.
- The final median concordance rate achieved was 71%, exceeding the initial study goal.
Conclusions:
- A multifaceted quality improvement initiative successfully increased the rate of pediatric asthma patients discharged on GINA guideline-concordant maintenance regimens.
- The study demonstrated the effectiveness of combining education, audit and feedback, standardized documentation, and decision support in improving asthma care.
- The interventions led to a substantial improvement in adherence to the latest GINA guidelines for asthma management in children.
Introduction:
The 2019 Global Initiative for Asthma (GINA) report called for changes in the approach to children with asthma. It focused on reducing morbidity and mortality and improving symptom control. This study aimed to increase the percentage of patients 6-18 years of age admitted for asthma exacerbations who received GINA guideline-concordant controller regimens from 39% to 50% within 6 months.
Methods:
Using the Model for Improvement framework, we garnered insight from pertinent stakeholders to identify key drivers. Key drivers identified included knowledge of guidelines, appropriate screening for symptom control, access to appropriate medications, and family and staff buy-in. Interventions initially focused on education around the GINA report. Subsequently, they implemented audit and feedback for prescribers, changes to standardized documentation (ie, asthma action plans and discharge instructions) in the electronic health record, and improved access to decision-support tools for prescribers through QR codes. An electronic health record query identified patients, and a control chart tracked study data weekly to determine the impact of interventions over time.
Results:
The average baseline concordance rate before interventions was 39%, with marked variability. A shift in the centerline occurred the month after the interventions began, with a final median centerline at 71%.
Conclusions:
This quality improvement study used a multifaceted approach to increase the number of patients discharged on a home maintenance regimen concordant with the most recent GINA report.
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