P3.275: Implementation of Single Maintenance and Reliever Therapy Standard of Care Management Guidelines in Adolescent Asthma Patients in San Antonio Military Healthcare System

Purpose/Objectives: Major clinical and advocacy organizations for management of pediatric asthma, including the Global Initiative for Asthma (GINA), the National Heart, Lung, and Blood Institute (NHLBI), and the American Academy of Pediatrics (AAP), have adopted Single Maintenance and Reliever Therapy (SMART) as standard of care for asthma management in pediatric patients aged 12 years or older. In 2024, SMART adoption in patients 12-18 years old (yo) in the San Antonio Military Healthcare System (SAMHS) was less than 3% (n=849). This quality improvement (QI) initiative aims to increase appropriate adoption of SMART in pediatric patients 12-18yo with asthma in SAMHS to ≥50% by 01JAN2026.

Design/Methods: A multidisciplinary team, consisting of general pediatrics and pediatric pulmonology, was created to identify patients 12-18yo seen with an International Classification of Diseases (ICD-10) diagnosis code for asthma (J45) during the intervention periods. These patients were deemed appropriate and eligible for transition to guideline-concordant SMART management. This project consists of three Plan-Do-Study-Act (PDSA) cycles thus far: PDSA 1 (completed, July-September 2024): formalized SMART clinician education with didactic and case-based learning; PDSA 2 (completed, January-March 2025): creation of SMART patient and caregiver education materials, including a SMART-specific Asthma Action Plan, and; PDSA 3 (planned): increasing ease of access for clinician education and documentation with electronic health record dotphrase promulgation and workroom poster distribution.

The primary outcome measured was the proportion of encounters for asthma in the outpatient setting that had a SMART-appropriate metered dosed inhaler prescribed in their medication list, measured monthly. Process measures included clinician knowledge or understanding and the clinician’s practicing location and training status. Balancing measures included inpatient hospitalization rate for asthma at BAMC.

Results: Impact over time demonstrated a significant shift in the overall rate of SMART adoption with both provider and patient education. Special cause variation was seen in initial provider knowledge of SMART therapy. Common cause variation was noted in clinician type, location, and asthma hospitalization at BAMC. Overall, rate of appropriate SMART asthma management had an increase outside of common cause variation from 2.9% to a quarterly average of 31% within 9 months, based on data obtained from content analytics platform HealtheAnalytics (HealtheEDW) on 01APR2025 (Figure 1), with no evidence of increased inpatient hospitalizations for asthma exacerbations (Figure 2).

Conclusion/Discussion: PDSA Cycle 1 which focused on clinician-specific SMART education appears to address a major knowledge gap, and Cycle 2 also increased adoption. Deliverables generated thus far include a SMART-specific asthma action plan, a provider education poster, and a dotphrase on the MHS Genesis electronic health record (EHR) system, in addition to the primary outcome of improved SMART uptake. Future directions include expanding to additional SAMHS sites for continued adoption with targeted measures, efficiently implemented, to improve rate of transition to SMART standard of care.