WIP 15 - Reducing Racial Disparities in Asthma Care: Initiating Inhaled Corticosteroids for Pediatric Patients with Poorly Controlled Asthma in the Emergency Department

Publication Number: WIP 15.7469

Angela Amaniampong, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Bianca Nfonoyim Bernhard, Children's Hospital of Philadelphia, Cherry Hill, NJ, United States; Joseph J. Zorc, Children's Hospital of Philadelphia, Wynnewood, PA, United States

Background: In 2024, we observed an increase in high-acuity asthma cases in our emergency department (ED) and a cluster of seven asthma-related deaths in Philadelphia, where asthma rates are 3 times the national average. Asthma disproportionately affects marginalized communities, resulting in significant racial and socioeconomic disparities in its prevalence, exacerbations and related mortality. This highlights the urgent need to improve access to essential preventive medications such as inhaled corticosteroids (ICS). Global Initiative for Asthma guidelines recommend prescribing ICS during ED discharge for patients with uncontrolled asthma. Despite their proven effectiveness, studies have shown low rates of ICS prescription in EDs. Very few studies address this issue or demonstrate effective strategies for improvement. This IRB-exempt Quality Improvement study developed a novel approach to initiating ICS in the pediatric ED (PED) to improve outcomes, prevent future tragedies and decrease disparities in asthma care.

Objective: We aim to increase the initiation rate of ICS for patients with uncontrolled asthma discharged from the PED by 25% by April 2025 to reduce disparities in asthma care.

Design/Methods: We convened a multidisciplinary group to review current practices, develop driver diagrams, and test interventions through Plan-Do-Study-Act (PDSA) cycles. Using institutional guidelines, we defined uncontrolled asthma as not currently prescribed ICS and receiving 2 oral steroid courses within the past 6 months ( < 5 years of age) or 12 months (≥5 years of age). Surveys of ED providers identified key drivers, including provider buy-in regarding the importance of prescribing ICS and efficient systems to prescribe and track rates easily. Interventions in the October PDSA cycle focused on education around ICS prescribing guidelines. Using statistical process control charts to assess prescription rates, EHR data showed a baseline initiation rate of 6.3%, which rose to 14.4% during PDSA cycle one. Interventions, such as EHR alerts and provider feedback, are planned for the upcoming months.