Decision-making tool improves asthma management

Incorporating a concise asthma decision-making tool into medical records-whether paper or electronic-consistently improved documentation of key asthma indicators during pediatric primary care visits, a new study shows.

Investigators collected data for a total of 1,246 patients aged 6 months to 18 years from 2 inner-city, federally qualified health center programs in New York City. One program used paper records; the other electronic health records (EHRs).

Investigators conducted retrospective medical record reviews at the 2 sites for 1-year periods before and after implementation of the Asthma Toolbox, an asthma decision-making tool based on 2002 National Asthma Education and Prevention Program (NAEPP) guidelines. The toolbox consists of a set of questions to guide providers through pediatric asthma assessment and management; the questions are printed on every encounter form (for the facility with paper records) or programmed into the EHR as a dropdown checklist. The tool documents 3 major asthma indicators: asthma severity and/or control, ED visits, and hospitalization.

Commentary

The Centers for Disease Control and Prevention reports that in 2009 the prevalence of asthma among children younger than 18 years was 9.6%. The prevalence was higher in poor children (13.5%) and higher still among non-Hispanic black children (17%). Among children and adults with asthma, about one-third have a written asthma action plan and about two-thirds have been taught how to respond to an asthma attack (MMWR Morb Mortal Weekly Rep. 2011;60[17]:547-552). This is a big problem. NAEPP guidelines emphasize recognition and severity classification of asthmatics as a first step in providing appropriate education and preventive care. This study shows how using the medical record as a prompt can improve that step in care of asthmatics, helping us to do the right thing for our patients -Michael Burke, MD