Improving Asthma Care Documentation with a Digital Tool–Experience in a Pediatric Institution

Abstract

Background Asthma affects approximately 10% of Australian children. Electronic medical record (EMR) systems and clinical decision support initiatives have been shown to improve the delivery of asthma care. Our institution implemented an EMR-based asthma “hub,” which collates asthma-related information to a central location within a patient's record, provides a template to collect relevant clinical information, allows clinicians to evaluate a patient's history and presentation in a systematic manner and prompts relevant actions.

Objective The aim of the study is to measure year-on-year improvement in asthma-related documentation and provide a key gold-standard aspects of asthma management after the introduction of an EMR asthma “hub” tool in the outpatient setting.

Methods The asthma “hub” was introduced in November 2020. A chart review was conducted of all patients who attended the Complex Asthma Clinic between January-April 2020 and January-April 2021. The provision and presence of documentation of core aspects of asthma care were described in percentages and comparisons of pre- and post-introduction of the asthma “hub” were assessed.

Results There was a significant increase in the documentation of asthma triggers, including smoking/smoker exposure, (47.5–92.6%, p <0.001), current asthma action plans (70.4–86.3%, p = 0.02), and severity scores (46.3–81%, p <0.001) post the introduction of the asthma “hub.” There was no significant difference in documentation of reliever (as required) or regular preventer medications.

Conclusion An evidence-based EMR intervention improved the documentation and provision of aspects of asthma care in an outpatient clinic setting at a tertiary pediatric hospital, suggesting replication in the inpatient and emergency settings would be worthwhile. Further research is required to understand the tool's impact on clinical outcomes and on clinical efficiency and workflow.

Keywords

asthma - pediatric hospital - informatics - electronic medical record

Protection of Human and Animal Subjects

The study was approved by the RCH Human Research and Ethics Committee (Ethics approval number QA/69208/RCHM-2020).

Publication History

Received: 28 April 2022

Accepted: 17 August 2022

Accepted Manuscript online:
31 August 2022

Article published online:
19 October 2022

• References

• 1 Australian Institute of Health and Welfare (AIHW) Cat No. . ACM 33 Asthma; 2020
• 2 Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis 2014; 18 (11) 1269-1278
• 3 National Asthma Council Australia. . Australian Asthma Handbook – Management in Children. Accessed December 15, 2021 at: https://www.asthmahandbook.org.au/management/children
• 4 Pijnenburg MW, Fleming L. Advances in understanding and reducing the burden of severe asthma in children. Lancet Respir Med 2020; 8 (10) 1032-1044
• 5 Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax 2004; 59 (02) 94-99
• 6 Zemek RL, Bhogal SK, Ducharme FM. Systematic review of randomized controlled trials examining written action plans in children: what is the plan?. Arch Pediatr Adolesc Med 2008; 162 (02) 157-163
• 7 Abramson MJ, Bailey MJ, Couper FJ. et al; Victorian Asthma Mortality Study Group. Are asthma medications and management related to deaths from asthma?. Am J Respir Crit Care Med 2001; 163 (01) 12-18
• 8 Cicutto L, Dingae MB, Langmack EL. Improving asthma care in rural primary care practices: a performance improvement project. J Contin Educ Health Prof 2014; 34 (04) 205-214
• 9 Chapman KR, Boulet LP, Rea RM, Franssen E. Suboptimal asthma control: prevalence, detection and consequences in general practice. Eur Respir J 2008; 31 (02) 320-325
• 10 FitzGerald JM, Boulet LP, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J 2006; 13 (05) 253-259
• 11 Australian Bureau of Statistics (ABS). Australian Institute of Health and Welfare (AIHW) Microdata: National Health Survey, 2017 -2018, detailedmicrodata, DataLab. ABS cat. no. 4324.0.55.001. Canberra: ABS. Findings based on AIHW analysis of ABS microdata 2019; Accessed December 15, 2021 at: https://www.abs.gov.au/statistics/microdata-tablebuilder/available-microdata-tablebuilder/national-health-survey
• 12 Gupta S, Price C, Agarwal G. et al. The Electronic Asthma Management System (eAMS) improves primary care asthma management. Eur Respir J 2019; 53 (04) 1802241
• 13 Bender BG. Electronic health record–generated interventions to reduce asthma risk: seeing the glass half full. J Allergy Clin Immunol 2014; 2 (04) 457-458
• 14 Zeiger RS, Schatz M, Li Q, Solari PG, Zazzali JL, Chen W. Real-time asthma outreach reduces excessive short-acting β2-agonist use: a randomized study. J Allergy Clin Immunol Pract 2014; 2 (04) 445-456
• 15 Taite A, Podgers D, Olajos-Clow J. et al. Enabling asthma management and outcomes monitoring through standardized EMR data and eTools. Eur Respir J 2017; 50 (Suppl. 61) PA2778
• 16 Tiase VL, Wawrzynski SE, Sward KA. et al. provider preferences for patient-generated health data displays in pediatric asthma: a participatory design approach. Appl Clin Inform 2021; 12 (03) 664-674
• 17 Farzandipour M, Nabovati E, Sharif R, Arani MH, Anvari S. Patient self-management of asthma using mobile health applications: a systematic review of the functionalities and effects. Appl Clin Inform 2017; 8 (04) 1068-1081
• 18 Fleming L, Murray C, Bansal AT. et al; U-BIOPRED Study Group. The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts. Eur Respir J 2015; 46 (05) 1322-1333
• 19 Guerra S, Stern DA, Zhou M. et al. Combined effects of parental and active smoking on early lung function deficits: a prospective study from birth to age 26 years. Thorax 2013; 68 (11) 1021-1028