Improving Single Maintenance and Reliever Therapy for Patients Admitted for Asthma Exacerbation

Area of Science:

• Pediatric pulmonology
• Quality improvement science
• Health equity research

Background:

• Single maintenance and reliever therapy (SMART) is guideline-recommended for school-aged children with poorly controlled persistent asthma in the US.
• Pediatric inpatient providers are crucial for prescribing SMART to high-risk asthma patients.
• Existing SMART prescription rates at discharge were suboptimal (17%), necessitating targeted interventions.

Purpose of the Study:

• To increase the proportion of SMART prescriptions at discharge for eligible pediatric asthma patients from 17% to 40% by September 2023.
• To ensure equitable improvements in SMART prescribing across diverse patient populations (payor type, race, Child Opportunity Index).
• To address key drivers of SMART prescription: prescriber familiarity, culture, decision support, and logistics.

Main Methods:

• A quality improvement project utilizing 10 Plan-Do-Study-Act cycles.
• Interventions focused on education and clinical decision support to address identified drivers.
• Inclusion criteria: pediatric patients with inhaled controller medication, and ≥2 asthma exacerbation-related hospitalizations/ER visits within 12 months.

Main Results:

• SMART prescription at discharge increased from 17% to 38% and was sustained for 19 months.
• The increase was observed across demographic strata, including Black patients, those with government insurance, and those with low Child Opportunity Index.
• The project involved 312 hospital encounters for 215 unique pediatric patients between January 2021 and December 2023.

Conclusions:

• Quality improvement methodology effectively increased SMART prescriptions at discharge for pediatric asthma exacerbation.
• The interventions demonstrated success in reducing disparities in asthma care.
• Sustained improvements in SMART prescribing contribute to better asthma management in pediatric populations.