1 / 16

Presenter: Delaney Gracy, MD, MPH

Impact of the “Asthma Toolbox” for Improving Documentation of Pediatric Asthma Management in an Urban Community Health Center. Presenter: Delaney Gracy, MD, MPH Co-Authors: Alan Shapiro, MD; Ariel Sarmiento, MPH; Wendy Quinones, BSN, RN, MSN, LPNP; Jo Applebaum, MPH Academy Health

ulysses-soto
Télécharger la présentation

Presenter: Delaney Gracy, MD, MPH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Impact of the “Asthma Toolbox” for Improving Documentation of Pediatric Asthma Management in an Urban Community Health Center Presenter: Delaney Gracy, MD, MPH Co-Authors: Alan Shapiro, MD; Ariel Sarmiento, MPH; Wendy Quinones, BSN, RN, MSN, LPNP; Jo Applebaum, MPH Academy Health National Research Meeting Washington DC, June 8, 2008

  2. Childhood Asthma Initiative • A multidisciplinary program to improve asthma care for severely disadvantaged and under-served pediatric population since 1997 • Funded by the Picower Foundation • Implemented in Community Pediatric Programs of the Children’s Hospital at Montefiore • South Bronx Health Center for Children and Families (FQHC) • New York Children’s Health Project (HCH)

  3. Research Objective • To evaluate a standardized provider reminder tool developed to document the assessment and treatment of pediatric asthma patients in a primary care setting

  4. Population Studied • Pediatric patients at the South Bronx Health Center for Children and Families • community health center • underserved inner-city neighborhood • 96% minority • 27% pediatric asthma prevalence (2006) • childhood asthma hospitalization rates in community served twice that of NYC overall (9.6-11.0 vs 5.4/1000)

  5. Asthma Toolbox • Boxed set of questions based on NHLBI guidelines printed on all pediatric medical chart forms (well child, follow-up and walk-in forms) • Prompts providers to consistently and accurately assess and treat pediatric asthma patients in a busy primary care setting • Use of NHLBI guidelines facilitated by streamlined set of questions that can be completed quickly

  6. Sample Toolbox

  7. Study Design • Chart review conducted to determine whether the Asthma Toolbox improved documentation of: • asthma severity classification • prescribing of controller medications • visits to the emergency department (ED) • hospitalizations

  8. Study Design(cont’d) • Sample (N=300) • 100 patients for each measurement period • randomly selected • ages 6 mo to 20 y with a non-urgent visit • Measurement periods • pre: 11/1/04-10/31/05 • post: 12/1/05-11/30/06 • late post: 1/1/07-6/30/07

  9. Study Design(cont’d) • Chart review • Last asthma visit in measurement period selected for review • If visit excluded, previous visit reviewed • Statistical analysis • Chi-square tests used to compare percentage of patients with variables documented • pre- vs post-; post- vs late post-implementation

  10. p=.000 p=.000 100 95 90 84 82 p<.01 p=.000 62 58 Percent (%) 50 16 Severity Overall Persistent On Controller Findings: Documentation of Assessment and Treatment Chi-square tests used to compare percentage of patients with variables documented at last eligible visit in the measurement period.

  11. p=.000 all comparisons Percent (%) Prior 4 mo Prior 12 mo Findings: Documentation of ED Visits Chi-square tests used to compare percentage of patients with variables documented at last eligible visit in the measurement period.

  12. p=.000 all comparisons Percent (%) Prior 4 mo Prior 12 mo Findings: Documentation of Hospitalization Chi-square tests used to compare percentage of patients with variables documented at last eligible visit in the measurement period.

  13. Conclusions • The Asthma Toolbox significantly improved the documentation of key variables in pediatric asthma management, including asthma severity classification and prescribing of controller medications in persistent asthmatics • A standardized brief provider-prompt assisted providers in complying with current asthma guidelines in the context of complex medical encounters • Acceptance of provider-prompt demonstrated by high percentage of usage

  14. Implications for Primary Care Practice and Policy • Use of provider-prompts incorporated into the medical record can improve adherence to clinical guidelines • Assessment, treatment and monitoring of pediatric asthmatics can be improved in a busy primary care setting • Consistent documentation in the chart can assist in quality improvement activities by facilitating data collection from the medical record and improve outcome tracking

  15. Next Steps • The Asthma Toolbox has been revised to reflect NHLBI 2007 guidelines • To be incorporated into adult medical record forms • The Asthma Toolbox has been adapted for and will be incorporated into an electronic health record template

  16. Thank You

More Related