Prompts in electronic health records improve guideline-based asthma care
Click Here to Manage Email Alerts
Key takeaways:
- Time constraints may prevent providers from evaluating asthma severity or control.
- Providers initiated guideline-based action after prompts even during visits that were not related to asthma.
TORONTO — Prompts in electronic health records increased the use of guideline-based preventive asthma care for children, according to a study presented at the Pediatric Academic Societies Meeting.
“There are many barriers to guideline-based asthma care on a system, patient and provider level,” Marina Reznik, MD, MS, vice chair for clinical and community-based research at Children’s Hospital at Montefiore, told Healio.
At the provider level, these barriers may include clinician awareness of guidelines and disagreement with these guidelines, Reznik, who also is professor of pediatrics at Albert Einstein College of Medicine, explained.
These barriers also include time constraints during office visits for evaluating asthma severity or control, including a need to assess and address asthma triggers, adherence and comorbid conditions, she continued.
Also, clinicians need to refer patients to a subspeciality if needed, provide appropriate medical therapy and educate families about asthma, Reznik added.
“All within a 15-minute visit,” she said.
The pragmatic, cluster randomized controlled trial was conducted at 18 pediatric and family practice clinics in the Bronx, New York, between 2017 and 2022.
The intervention group had prompts with guideline-based decision support built into their EHR as well as education about guideline-based care. The control group did not have any prompts. Screenings for asthma severity and control administered by nursing staff were built into the EHR for both groups.
The cohort, comprising 530 children aged 2 to 12 years with persistent asthma, included 265 in the intervention group and 265 in the control group, seen by 80 providers in the intervention group and 68 in the control group.
Providers took preventive action for 91% of the children in the intervention group and 74% in the control group (P < .01). Also, 69% of the visits in the intervention group and 53% of those in the control group included assessments for triggers and comorbidities (P < .001).
Compared with the control group, the intervention group also had more changes in preventive medication (47% vs. 35%; P = .028), asthma education (72% vs. 39%; P < .001) and recommendations for follow-up visits within 2 to 6 weeks (45% vs. 19%; P < .001).
The type of visit did not have any significant differential effect (P < .05), the researchers said. Additionally, 68.4% of the providers in the intervention group and 42.1% of those in the control group took guideline-based action even in visits that were not related to asthma (P = .002), which Reznik said was surprising.
“During asthma-related visits, it is expected that clinicians will follow guidelines and provide guideline-based asthma care,” Reznik said.
“During non-asthma-related visits, such as when a child with asthma presents for an unrelated acute medical issue or a follow-up visit for something other than asthma, children were still more likely to receive guideline-based asthma care,” she continued.
Based on these findings, the researchers said that the incorporation of systematic screenings and prompts into routine visits may improve care and outcomes for urban children with asthma.
“This is the first and important step in asthma care,” Reznik said.
Reznik noted that she and her team built these prompts into their Epic EHR system.
“These prompts can be developed and incorporated into other EHR systems,” she said. “We plan to discuss with Epic headquarters about the possibility of having these prompts be available in Epic for other institutions who have Epic EHR.”
Staff participation in these prompts and screenings is important to their success, Reznik said.
“For our nursing staff, the screening for asthma severity and level of control has become a standard practice. Ensuring all new nursing staff is trained when onboarded would be important. The same would apply for clinicians who are new to practices,” she said.
“Also, having asthma champions at the sites who would provide reminders and ongoing encouragement to continue following guideline-based care would ensure sustainability of the prompt use,” she continued.
The researchers plan on further examining these findings.
“We are continuing with additional data analyses to better understand intervention implementation, processes and effect on patient clinical outcomes,” Reznik said.