483 - Boosting Asthma Care in Pediatric Primary Care: Integrating Validated Screening and Just-In-Time Management Plans

Publication Number: 483.3653

Karen L. Warman, The Children's Hospital at Montefiore, Bronx, NY, United States; Natashaliz luna, The Children's Hospital at Montefiore, bronx, NY, United States; Caitlin Gilman, The Children's Hospital at Montefiore, Scarsdale, NY, United States; Kathleen Asas, The Children's Hospital at Montefiore, Scarsdale, NY, United States

Background: Poorly controlled asthma is common in US children and frequently goes unrecognized. At our urban primary care site, asthma is prevalent and low health literacy coupled with the complexity of providing asthma guidelines-based care make optimizing asthma management challenging.

Objective: We aimed to improve asthma care delivery for 4-18-year-old children during primary care visits by increasing use of written, validated, patient-completed asthma control measures coupled with just-in-time, score-based, guideline recommended treatment plans, from 0% to >55% from 1/24 to 9/24.

Design/Methods: In a large, inner-city, federally qualified health center, a team of front desk staff, nurses and physicians worked together to create an office workflow for asthma screening (Figure 1) and just-in-time plans (Figure 2). We implemented 5 sequential interventions (Figure 3). The front desk staff began giving age-appropriate, double-sided, English/Spanish, screens, The Child Asthma Control Test © or Asthma Control Test ©, to families at registration. We held a stakeholder meeting promoting a team approach to screening, followed by individualized training of physicians on specific smartphrase use for just-in-time, guideline-based asthma care based upon scores. Team members completed a tracking sheet for one-week to examine workflow. Nurses began to enter the data into EPIC flowsheets, and we modified our smartphrases to pull responses into the note and tracked the office flow for a week. We began noting asthma in the EPIC notes section to alert staff at the time of registration to an asthma diagnosis. For our balancing measure, we examined asthma screening for children, ages 2 – 4 years old, with our focus on 4 - 18-year-olds.

Results: At baseline in 1/24, there were no patient-completed, written asthma control screenings. By 4/24, the median completion of written asthma screens, with just-in-time documentation of a guideline-based recommendations, was 61% for children ages 4-18 years old (Figure 3). Notably, our balancing measure, screening of 2–4-year-olds, also increased from 33 to 56%. We achieved and sustained our goal metrics for 3 of 4 key interventions. Data collection is ongoing.

Conclusion(s): This QI project demonstrated that implementation of asthma screening using written, validated, low health literacy tools with the incorporation of just-in-time, asthma guideline-based recommendations is feasible and sustainable. Families were engaged in the screening and the physicians liked the ease of documentation. This low-cost intervention could be replicated to boost guideline-based asthma care in primary care settings.

Office Process Flow Chart - Integrating Asthma Control Screening
Figure 1.

Physician Process Control Map - Just-in-Time Guideline-based Asthma Management Plans
Figure 2.

Percent of children with asthma, 4 - 18 years old, screened for asthma control and with a just-in-time guideline-based plan at a primary care visit.
Figure 3.

Office Process Flow Chart - Integrating Asthma Control Screening
Figure 1.

Physician Process Control Map - Just-in-Time Guideline-based Asthma Management Plans
Figure 2.

Percent of children with asthma, 4 - 18 years old, screened for asthma control and with a just-in-time guideline-based plan at a primary care visit.
Figure 3.