Electronic Health Record (EHR) Decision Support to Improve Outpatient Asthma Care

To determine whether an innovative clinical decision support system embedded in an existing electronic health record (EHR) will improve provider adherence to the existing National Asthma Education and Prevention Program (NAEPP) guidelines. 12 primary care pediatric practices at The Children's Hospital of Philadelphia(both urban and suburban sites) will be randomized to receive either a passive EHR (control sites) or an interactive decision support system (intervention sites).

After receiving a standardized education module based on NAEPP guidelines, 12 primary care pediatric practices (both urban and suburban sites) will be randomized to receive either a passive EHR (control sites) or an interactive decision support system (intervention sites). The primary outcome of interest will be the proportion of patients on appropriate asthma controller medication compared over time. Secondary outcomes include the proportion of asthma patients with: 1) an updated asthma action plan 2) documentation of spirometry performed (6 to 17 yrs) and 3) an updated problem list reflecting current asthma severity. After hours calls to providers and types of office visits related to asthma will be tracked. 4) In addition, measurement of asthma-related quality of life and missed school and work in a sample of 200 subjects from each group will be performed. Contextual factors at the clinic and patient level will be examined to assess their association with outcomes of interest. If shown to be successful, this type of clinical decision support, embedded within the EHR, has the potential to be a powerful tool to improve the implementation of asthma guidelines and clinical practice guidelines for other conditions and illnesses in the primary setting.

clinical decision support tool, electronic health record, control tool, spirometry, quality of life survey, provider survey

Practices with the EHR implemented will be randomized have the asthma disease management tools available passively (the control group).

The intervention sites will have decision support alerts and reminders activated to guide providers toward these tools in the appropriate situations.

The asthma disease management toolkit available to all practices in the EHR will consist of four elements: A data entry tool for capturing asthma control data Standardized documentation templates to facilitate severity classification Order sets to facilitate ordering controller medications An asthma care plan that can be supplied to families

Three alerts and two reminders will be programmed: Alert providers to enter asthma severity classification if none is on file Alert providers to prescribe controller medications for persistent asthma if none on file Alert providers to complete an asthma care plan if none on file Remind providers to review the asthma care plan if it is already on file by providing a link to the form Remind providers that educational content is available on-line by providing a web link

The primary outcome measure is the proportion of persistent asthmatic patients with at least one prescription for a controller medication in each period. There are two periods of study: baseline and intervention.

Secondary outcomes include the proportion of persistent asthmatic patients with 1)an updated asthma action plan, 2)spirometry as needed 3)problem list with current asthma severity 4)asthma-related quality of life scores 5)absent school and work days.