Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System
Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System
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DOI：
10.3122/jabfm.2015.03.140248
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发表时间：
2015-05-01
影响因子：
2.9
通讯作者：
Dulin, Michael
中科院分区：
文献类型：
--
作者：
Kuhn, Lindsay;Reeves, Kelly;Dulin, Michael
简介：哮喘是一种慢性气道疾病，可能难以管理，导致不良结局和高成本。哮喘行动计划帮助患者进行自我管理，但由于指南的复杂性，提供者对这一建议的遵守程度有限。这个项目的目的是嵌入一个电子哮喘行动计划决策支持工具（eAAP）到医疗记录，以简化基于证据的指南提供者在护理点，创建个性化的病人讲义，并评估对疾病outcome.Methods的影响：eAAP的发展发生在4个阶段：基于网络的原型创建，多学科团队参与，试点和全系统的传播。医疗记录和医院账单数据比较eAAP收据与匹配controls.Results：2012年12月和2014年9月之间，5174例哮喘患者（类似于10%）接受eAAP之前和之后的哮喘急性发作频率。结果显示，与对照组相比，接受eAAP治疗与儿童哮喘急性发作显著减少相关，包括需要口服类固醇的几率降低33%（P <0.001）。等效成人措施没有统计学意义。结论：这项研究支持现有的证据表明，患者自我管理在减少哮喘急性发作中起着重要作用。我们展示了利用技术通过eAAP提供基于指南的决策支持的可行性，解决了常规实践中实施的已知挑战。
Introduction: Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes.Methods: eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls.Results: Between December 2012 and September 2014, 5174 patients with asthma (similar to 10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant.Conclusions: This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice.