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Provider perspectives on the implementation of an evidence-based acute asthma pathway in the pediatric primary care
Jessica C Gregory1, Kayla C Jones2, Rachel Sagor1
1Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
Insights
Pediatric primary care providers found the acute asthma care pathway beneficial, promoting standardized, evidence-based treatment. Optimizing usability and providing performance feedback can further enhance its adoption and impact on asthma care.
Area of Science:
- Pediatric Primary Care
- Healthcare Implementation Science
- Asthma Management
Background:
- Standardized acute care asthma pathways improve outcomes in emergency and inpatient settings.
- An ambulatory acute asthma care pathway was developed and implemented in a pediatric primary care clinic.
Purpose of the Study:
- To qualitatively assess provider perceptions of the benefits, disadvantages, facilitators, and barriers of an ambulatory acute asthma care pathway.
- To understand how pediatric primary care providers engage with and utilize the implemented asthma care pathway.
Main Methods:
- Semi-structured interviews were conducted with 13 pediatric primary care clinicians.
- The Promoting Action Research on Implementation in Health Services (PARiHS) framework guided the interview, codebook, and analysis.
- Thematic analysis was used to identify key themes and subthemes from provider interviews.
Main Results:
- Providers value the standardization and evidence-based care promoted by the pathway.
- Provider experience with asthma management and electronic order sets influences pathway engagement.
- Clinical context impacts pathway utilization, with successes and areas for improvement identified.
Conclusions:
- Pediatric primary care providers report positive experiences and recognize the benefits of the standardized asthma care pathway.
- Increased performance feedback and improved usability are key opportunities for optimizing pathway uptake.
- Future research will focus on evaluating the pathway's impact on clinical asthma outcomes.
Background:
Standardized acute care asthma pathways are associated with improved asthma outcomes in emergency department and inpatients settings. We developed and implemented an ambulatory acute asthma care pathway (the "Pathway") in the pediatric primary care clinic of our academic safety-net hospital.
Objective:
To qualitatively assess perceived benefits, disadvantages, facilitators, and barriers associated with use and implementation of this Pathway among pediatric primary care providers.
Methods:
We conducted semi-structured interviews with primary care providers to elicit their perspectives about the Pathway. The interview guide, codebook, and analysis were guided by the Promoting Action Research on Implementation in Health Services (PARiHS) framework. Interviews were analyzed to identify themes and subthemes.
Results:
Participants included 13 clinicians (attending physicians, nurse practitioners, and resident trainees). Major themes included: (1) Providers appreciate standardization of care facilitated by the Pathway and perceive the Pathway as promoting evidence-based care; (2) providers' experience managing acute asthma and with electronic order sets affects the way they engage with the Pathway; more data about performance measures would help; (3) the clinical context influences the way providers utilize the Pathway; and (4) providers identified successes of Pathway implementation (i.e. provider meeting presentations, in-clinic support from Asthma Team "champions") as well as opportunities for improvement.
Conclusions:
Providers report positive experiences with the Pathway and recognize the benefits of standardized, evidence-based care. Increased feedback about performance and outcomes and strategies to improve usability were proposed as opportunities for optimizing Pathway uptake. Future studies will evaluate the impact of the Pathway on improving clinical outcomes.
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