P2.270: ACT Now: A Quality Improvement Project to Improve Asthma Control Test Documentation in a Pediatric Primary Care Clinic

Purpose/Objectives: The aim of this quality improvement (QI) project was to increase the use of the Asthma Control Test (ACT) during asthma visits for children aged 4–20 years at a pediatric primary care teaching clinic. The improvement team sought to improve both ACT questionnaire completion and provider documentation of ACT scores from a baseline of 0% in January 2025 to ≥50% by March 2025. This initiative aimed to promote standardized, evidence-based asthma management.

Design/Methods: Residents utilized the Model for Improvement to address key drivers for decreased utilization of the ACT score. Plan-Do-Study-Act (PDSA) cycles involved tests of change and data collection from January through March 2025. Interventions included provider and nurse education, workflow redesign, and electronic health record (EHR) clinical decision support. The EHR was updated to auto-assign the ACT questionnaire for asthma visits. During the check-in process, patients aged 4 and above are asked to indicate whether they are being seen for asthma. If they respond yes, the system automatically assigns the appropriate ACT questionnaire based on age: the childhood version for ages 4–11 and the adolescent/adult version for patients 12 and older. The improvement team edited the documentation macro for the asthma care plan to include the ACT score. Weekly chart reviews of asthma visits yielded percentages of charts with ACT completion and ACT provider documentation in the visit note. The Institutional Review Board (IRB) determined this project was exempt from IRB review.

Results: Data were collected over 12 weeks. An average of 11.5 ± 5.7 charts per week met the inclusion criteria. The clinic achieved ACT screening in 100% of 4–20-year-old asthma visits within 3 weeks and sustained this over the project period. Documentation of the ACT in the provider note reached 70% by week 6 and sustained over 90% for 6 consecutive weeks. Provider education appeared to have limited short-term impact on documentation practices. The run chart (Figure.1) demonstrates the most dramatic improvement following the documentation macro edit to include the ACT score.

Conclusion/Discussion: ACT screening at asthma visits was achieved within 3 weeks and sustained over 9 consecutive weeks. Provider documentation of the ACT was >50% by 6 weeks and was sustained over 6 consecutive weeks. Simple interventions made this project feasible in a multi-physician resident clinic. Clinical decision support that facilitates data collection and standardizes clinical documentation was associated with the greatest improvement in physician documentation of the ACT. Barriers included frequent physician rotation in a resident clinic. Passive strategies, such as email reminders, had minimal impact. Limitations include the short duration and single-site scope. Future steps include monitoring sustainability, assessing workflow impact, expanding implementation, and evaluating how ACT documentation influences asthma management.