34 - Asthma Action Plan Completion Rates: Implementation of Pediatrician-Identified Improvements

Poster Number: 34
Publication Number: 34.300

Karen H. Pletta, University of Wisconsin School of Medicine and Public Health, Stoughton, WI, United States; Bradley Kerr, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Megan A. Moreno, University of Wisconsin, Madison, WI, United States

Background: The American Academy of Pediatrics recommends developing Asthma Action Plans (AAPs) for asthma control, however the AAP completion rates in the primary care pediatric clinics of our large medical system were declining despite standardized quality approaches. Thus, a mixed method study was completed among pediatricians in our system to identify barriers to AAP completion. Barriers included: 1) need for staff involvement for outreach, 2) need for pre-visit planning and Asthma Control Test (ACT) administration, 3) printer location not in or near the exam room, and 4) slow electronic health record (EHR) flow.

Objective: This study aimed to implement interventions to increase AAP completion rates based on pediatrician-identified barriers.

Design/Methods: AAP flow changes were developed for our primary care pediatric clinics in response to pediatrician-identified barriers. Interventions included: 1) Medical staff were asked to complete asthma outreach to update AAPs and schedule well visit if due. 2) Medical staff were asked to identify well-visit patients due for AAPs and initiate ACT at the start of the well visit. 3) Printers closest to exam rooms were identified and linked to exam room computers. 4) A new EHR link was developed for faster flow. The AAP completion rate was recorded at baseline and at 8 monthly time points following implementation of the intervention. AAP completion rate changes were assessed using a statistical process control chart for proportions (p-chart).

Results: Across our 5 primary care pediatric clinics with 40 pediatricians, the AAP completion rate increased from 51.4% at baseline to 75.6% after 8 months. A p-chart showed more than 6 consecutive points increasing, suggesting special cause variation (see attached p-chart).Conclusion(s): Mixed method research approaches that integrate pediatrician-identified improvements can help develop successful quality interventions. Focused changes for pediatric clinics can result in increased Asthma Action Plan delivery and may improve asthma control for children.
Asthma Action Plan Completion Rates by Primary Care Pediatricians