An Electronic Decision Support Tool to Improve Outpatient Asthma Care

• The proportion of patients on appropriate asthma controller medication at the end of the trial [ Time Frame: assessed at each visit ]
  each patient who is classified as having persistant asthma should be on at least one appropriate controller medication for asthma.
  
  

• 1) an updated asthma action plan [ Time Frame: updated at least once per year ]
  Each patient should have an asthma care plan updated once per year
  
  
• 2)documentation of spirometry(6 to 18 yrs)in those with asthma [ Time Frame: spirometry should be done once per year ]
  Each patient should have had spirometry at least once per year.
  
  
• 3) an updated problem list that reflects an assessment of asthma severity [ Time Frame: tthe asthma severity should be on the problem list ]
  each patient should have their asthma severity classification on the thier chart
  
  

National Asthma Education and Prevention Program guidelines (NAEPP) exist, but are under used in Primary Care. In addition, implementation of the guidelines has been shown to be vary according to the location of practice and other contextual factors.

The Children's Hospital of Philadelphia Pediatric Research Consortium (PeRC), a practice-based research network will determine whether an innovative clinical decision support system embedded in an existing electronic health record (EHR) will improve provider adherence to the existing NAEPP guidelines.

After receiving a standardized education module based on NAEPP guidelines, 10 primary care pediatric practices (both urban and suburban) will be randomized to receive either a passive EHR (control sites) or an interactive decision support sytem (intervention sites).

The primary outcome of interest will be the proportion of patient son 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 17years) and 3) an updated problem list reflecting current asthma severity. After hours calls to providers and types of office visits related to to asthma will be tracked. Contextual factors at the clinic and patient level will be examined to assess their association with the outcomes of interest. 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

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.