Improving asthma care in a pediatric resident clinic.
Improving asthma care in a pediatric resident clinic.
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DOI：
10.1136/bmjquality.u214746.w6381
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Shaikh U
中科院分区：
文献类型：
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作者：
Lee J;Gogo A;Tancredi D;Fernandez Y Garcia E;Shaikh U
在门诊环境中，儿童哮喘的管理存在差异。遵守国家哮喘指南为哮喘管理提供了系统的标准化方法。在居民诊所中，常规和指南一致的哮喘护理之间存在差距。旨在提高住院医师对哮喘护理指南依从性的实践改进模块尚未得到持续利用，也尚未进行研究。我们的目标是在12个月内通过将以下指标的表现提高到75%来提高儿科住院医师诊所的指南一致性护理：肺量测定法检测;流感免疫接种建议;通过使用标准化问卷评估的控制水平;根据国家指南使用适当的药物;以及使用书面哮喘行动计划。国家心肺和血液研究所国家哮喘教育和预防计划专家小组报告3（NHLBI EPR-3）指南的儿科特定版本的总结随时可用，以增加提供者的教育。电子健康记录（EHR）的增强功能包括添加模板以创建标准化的哮喘行动计划、哮喘控制测试和儿科哮喘控制器药物订单集。我们还通过简化患者说明来解决患者教育问题。我们通过使用在线实践改进模块来监测我们的进展。我们发现使用标准化工具来确定控制水平（20%至81%）的统计学显著增加;流感免疫接种的建议（56%至97%）;国家药物治疗指南的使用（28%至98%）;哮喘行动计划的分发（29%至65%）;以及提供哮喘自我管理教育（35%至74%）。通过使用实践改进模块和电子健康记录来标准化儿童哮喘国家指南的实施，提高了对指南的依从性。该模块使我们能够确定改进目标，收集和分析我们的团队绩效数据，评估每个变化的影响，并重新设计我们的流程。提高对国家儿科哮喘护理指南的依从性在为哮喘相关并发症风险较高的服务不足人群提供护理的居民教学诊所等环境中尤为重要。
There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual and guideline-consistent asthma care in resident clinics. Practice improvement modules aimed at improving resident physician adherence to asthma care guidelines have not been consistently utilized and have not yet been studied. Our aim was to increase guideline consistent care in our pediatric resident clinic in a twelve-month period via increasing performance on the following measures to 75%: spirometry testing; influenza immunization recommendation; level of control assessed through the use of a standardized questionnaire; appropriate medications per national guideline; and use of written asthma action plans. A summarized pediatric-specific version of the National Heart Lung and Blood Institute National Asthma Education and Prevention Program Expert Panel Report 3 (NHLBI EPR-3) guidelines was made readily available to increase provider education. Electronic health record (EHR) enhancements included adding templates to create standardized asthma action plan, asthma control test and a pediatric asthma controller medication order-set. We also addressed the education of patients by simplifying patient instructions. We monitored our progress through the use of an online practice improvement module. We found statistically significant increases in use of a standardized instrument to determine level of control (20% to 81%); recommendation of influenza immunization (56% to 97%); use of national medication treatment guidelines (28% to 98%); distribution of asthma action plans (29% to 65%); and provision of asthma self-management education (35% to 74%). Standardizing the implementation of national guidelines for pediatric asthma through the use of a practice improvement module and electronic health records improved adherence to guidelines. The module allowed us to identify goals for improvement, collect and analyze our group performance data over time, assess the impact of each change, and redesign our process. Improving adherence to national pediatric asthma care guidelines is especially important in settings such as resident teaching clinics which provide care to underserved populations at higher risk for complications related to asthma.