P2.090: Improving Asthma Action Plan Use in Primary Care

Purpose/Objectives: Asthma is a prevalent chronic condition in pediatric primary care, and asthma action plans (AAPs) are recommended as a key component of asthma education and management. While their direct impact on clinical outcomes may vary, AAPs primarily serve as an educational tool to help patients and families manage asthma symptoms and respond to exacerbations. Using quality improvement (QI) methodology, the authors aimed to increase AAP use in a primary care clinic from a baseline of 9% to 20% among patients with a visit diagnosis of asthma over a one-year period.

Design/Methods: We employed standard QI methodologies to define our aim, assess process performance, and monitor interventions. Data were collected in three phases: six months prior to the interventions, during the interventions, and with plans for continued data collection during the sustainability phase. Our process measure was the percentage of patients with asthma addressed during the visit who had an AAP documented in their electronic medical record (EHR). After collecting baseline data, we defined our aim, mapped the current process and identified common failure states. We then identified key drivers, including clinic staff engagement, standardized processes for AAP completion, and technology-driven reminders.
Initial Plan-Do-Study-Act (PDSA) cycles focused on enhancing attending and resident engagement and education, as well as incorporating AAP completion into their standard workflow. This standardization occurred through lectures at clinic staff meetings and resident didactics on how to complete the AAP in the EHR. Subsequent PDSA cycles focused on implementing EHR reminders to prompt providers when asthma was listed as a visit diagnosis, along with a copy-forward function for AAPs that remained unchanged from prior visits. Additional interventions included performance incentives, offering the AAP in alternative languages, and sharing individual provider completion data.
Performance was audited on a bi-weekly basis, and results were plotted on standard run and control charts.

Results: Since the onset of the project, the mean line for AAP completion for visits with a diagnosis of asthma increased from 9% to 47%, with consistent performance within stable control limits during the study period.

Conclusion/Discussion: AAP completion for patients with asthma in this primary care clinic showed improvement above the initial goal of 20%. Physician and staff education proved to be effective tools for improving AAP completion rates. EHR tools were also successful in optimizing AAP documentation, with provider reminders integrated into a standardized workflow. Performance incentives, offering alternative language options, and sharing individual provider completion data were also effective tools that lead to enhanced AAP completion. Next steps include continued monitoring during the sustainability phase and expansion to other primary care sites within our hospital. Although not measured in this project, future studies should consider comparing asthma control and outcomes with asthma action plan completion.