Greenberg Jonathan, Prushinskaya Olga, Harris Joshua D, Guidetti-Myers Gillian, Steiding Jacqueline, Sawicki Gregory S, Gaffin Jonathan M
a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA.
J Asthma. 2018 Feb;55(2):180-187. doi: 10.1080/02770903.2017.1323916. Epub 2017 May 26.
Despite available and effective tools for asthma self-assessment (Asthma Control Test, ACT) and self-management (Asthma Action Plan, AAP), they are underutilized in outpatient specialty clinics. We evaluated the impact of a patient-centered checklist, the Asthma Passport, on improving ACT and AAP utilization in clinic.
This was a randomized, interventional quality-improvement project in which the Asthma Passport was distributed to 120 pediatric asthma patients over the duration of 16 weeks. The passport's checklist consisted of tasks to be completed by the patient/family, including completion of the ACT and AAP. We compared rates of completion of the ACT and AAP for those who received the passport versus the control group, and assessed patient/caregiver and provider satisfaction.
Based on electronic medical record data from 222 participants, the ACT completion rate was not significantly different between the passport and control groups, however, the AAP completion rate was significantly greater than control (30.0% vs. 17.7%, p = 0.04). When per-protocol analysis was limited to groups who completed and returned their passports, ACT and AAP completion rates were significantly greater than control (73.8% vs. 44.1% (p = 0.002) and 35.7% vs. 17.7% (p = 0.04), respectively). Nearly all participants reported high satisfaction with care, and surveyed providers viewed the passport favorably.
A patient-centered checklist significantly improved the completion rate of the AAP. For patient's who completed and returned the asthma passport, the ACT completion rate was also improved. Participants and providers reported high satisfaction with the checklist, suggesting that it can effectively promote asthma self-management and self-assessment without burdening clinicians or clinic workflow.
尽管有可用且有效的哮喘自我评估工具（哮喘控制测试，ACT）和自我管理工具（哮喘行动计划，AAP），但它们在门诊专科诊所的利用率较低。我们评估了以患者为中心的清单“哮喘护照”对提高诊所中ACT和AAP利用率的影响。
这是一项随机干预性质量改进项目，在16周的时间内，将“哮喘护照”分发给120名儿科哮喘患者。护照清单包括患者/家庭需要完成的任务，包括完成ACT和AAP。我们比较了接受护照的患者与对照组完成ACT和AAP的比率，并评估了患者/护理人员和提供者的满意度。
根据222名参与者的电子病历数据，护照组和对照组的ACT完成率没有显著差异，然而，AAP完成率显著高于对照组（30.0%对17.7%，p = 0.04）。当按方案分析仅限于完成并归还护照的组时，ACT和AAP完成率显著高于对照组（分别为73.8%对44.1%（p = 0.002）和35.7%对17.7%（p = 0.04））。几乎所有参与者都对护理表示高度满意，接受调查的提供者对护照评价良好。
以患者为中心的清单显著提高了AAP的完成率。对于完成并归还哮喘护照的患者，ACT完成率也有所提高。参与者和提供者对清单表示高度满意，这表明它可以有效促进哮喘自我管理和自我评估，而不会给临床医生或诊所工作流程带来负担。
