A quality improvement initiative on asthma management in a family medicine setting
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Date
2022
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Montana State University - Bozeman, College of Nursing
Abstract
Achieving control of asthma symptoms can improve quality of life and reduce hospitalizations. Clear clinical practice guidelines from the National Heart Lung and Blood Institute's Expert Panel Report 3 (2007) detail critical components for optimal asthma management. One component, the Asthma Control Test (ACT), is a standardized tool used to assess asthma control. Another component, the Asthma Action Plan, is an individualized plan formulated by the provider for asthma patients to help self-manage asthma. Problem: Organizational stakeholders at a family medicine clinic in southwest Montana identified that there was no standardized workflow for asthma management. The clinic has 1,238 asthma patients. In the past year, none have had asthma control assessed using a standardized tool, and only one patient has had an Asthma Action Plan completed. Methods: After collaboration with stakeholders, a brief educational intervention for providers and rooming staff and a new workflow to implement ACT screening and asthma action plan were developed. Electronic medical record reports and chart audits were used to monitor the completion of the ACT and Asthma Action Plans. A series of five one-week Plan-Do-Study-Act (PDSA) cycles were run to work toward goals of 100% completion of ACT at office visits, 100% of uncontrolled ACT scores addressed, and 80% of uncontrolled scores addressed with Asthma Action Plans. Results: During the first five weeks of the new workflow, 49 alerts were fired for ACT completion; 36 ACT screens were completed (73%); by the fifth week, rates increased steadily to 88.9%. Only six ACT screens revealed uncontrolled asthma; providers directly addressed 100% of those scores. None of those patients had an Asthma Action Plan completed; however, six other patients with well-controlled asthma did during this timeframe. Conclusions: While the project cannot assume the workflow improved outcomes for asthma patients, significant steps to adhering to clinical practice guidelines were made by introducing ACT screening and Asthma Action Plans. More work is needed to increase adherence to the new workflow, particularly Asthma Action Plan completion rates. Additionally, the clinic is now open to introducing additional elements of asthma guidelines in the future, such as peak flow meter use.