Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut.
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut; Division of Pediatric Pulmonary and Sleep Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; Central Connecticut Cystic Fibrosis Center, Hartford, Connecticut.
Ann Allergy Asthma Immunol. 2023 May;130(5):571-576. doi: 10.1016/j.anai.2023.01.016. Epub 2023 Jan 23.
This article reviews new approaches, facilitators, barriers, and opportunities to increasing adoption of standardized asthma management programs in the outpatient care setting.
Primary care clinicians providing asthma care in the outpatient setting are challenged by the complexity of guidelines and want standardization of tools that are easy to use and that can be integrated within their practice's workflow. Programs that integrate clinical decision support tools within a practice's electronic health record and provide support from specialists may enhance uptake of asthma management programs in the outpatient setting and reduce asthma morbidity. Lack of an implementation science framework, consideration for organizational context, and clinician buy-in are recently recognized barriers to adoption of asthma programs and improved asthma outcomes. In addition, many of these interventions are labor intensive, costly, and may not be capable of wide dissemination because of the EHR interoperability problem.
Programs that simplify the guidelines, integrate clinical decision support within the EHR, and ground their approach with an implementation science framework may improve the quality of asthma care provided in the outpatient setting.
本文综述了在门诊环境中增加采用标准化哮喘管理方案的新方法、促进因素、障碍和机会。
在门诊环境中提供哮喘护理的初级保健临床医生面临着指南的复杂性的挑战,他们希望使用标准化的工具,这些工具易于使用,并可以整合到他们的实践工作流程中。将临床决策支持工具集成到实践的电子健康记录中,并提供专家支持的方案可能会提高哮喘管理方案在门诊环境中的采用率,并降低哮喘发病率。缺乏实施科学框架、考虑组织背景和临床医生的认可,是最近被认识到的采用哮喘方案和改善哮喘结果的障碍。此外,由于电子健康记录的互操作性问题,许多这些干预措施都很费力、昂贵,并且可能无法广泛传播。
简化指南、在电子健康记录中整合临床决策支持,并以实施科学框架为基础的方案可能会提高门诊环境中提供的哮喘护理质量。