Herchline Daniel, Mitchell Michelle, Brannen Shanon, Scott Abbey, Patterson Skyler, Khan Sarah, Sauerwein Katrina, Treasure Jennifer D
From the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Pediatr Qual Saf. 2025 Jun 12;10(4):e818. doi: 10.1097/pq9.0000000000000818. eCollection 2025 Jul-Aug.
The 2019 Global Initiative for Asthma (GINA) report called for changes in the approach to children with asthma. It focused on reducing morbidity and mortality and improving symptom control. This study aimed to increase the percentage of patients 6-18 years of age admitted for asthma exacerbations who received GINA guideline-concordant controller regimens from 39% to 50% within 6 months.
Using the Model for Improvement framework, we garnered insight from pertinent stakeholders to identify key drivers. Key drivers identified included knowledge of guidelines, appropriate screening for symptom control, access to appropriate medications, and family and staff buy-in. Interventions initially focused on education around the GINA report. Subsequently, they implemented audit and feedback for prescribers, changes to standardized documentation (ie, asthma action plans and discharge instructions) in the electronic health record, and improved access to decision-support tools for prescribers through QR codes. An electronic health record query identified patients, and a control chart tracked study data weekly to determine the impact of interventions over time.
The average baseline concordance rate before interventions was 39%, with marked variability. A shift in the centerline occurred the month after the interventions began, with a final median centerline at 71%.
This quality improvement study used a multifaceted approach to increase the number of patients discharged on a home maintenance regimen concordant with the most recent GINA report.
2019年全球哮喘防治创议（GINA）报告呼吁改变哮喘患儿的治疗方法。其重点在于降低发病率和死亡率，并改善症状控制。本研究旨在将6至18岁因哮喘急性加重入院的患者中，在6个月内接受符合GINA指南的控制方案的比例从39%提高到50%。
我们使用改进模型框架，从相关利益相关者那里获取见解，以确定关键驱动因素。确定的关键驱动因素包括对指南的了解、对症状控制的适当筛查、获得适当药物的机会以及家庭和工作人员的支持。干预措施最初侧重于围绕GINA报告开展教育。随后，他们对开处方者实施审核和反馈，对电子健康记录中的标准化文件（即哮喘行动计划和出院指导）进行更改，并通过二维码改善开处方者获取决策支持工具的机会。通过电子健康记录查询确定患者，并使用控制图每周跟踪研究数据，以确定干预措施随时间的影响。
干预前的平均基线符合率为39%，存在明显差异。干预开始后的那个月，中心线发生了变化，最终中位数中心线为71%。
这项质量改进研究采用多方面方法，以增加出院时采用与最新GINA报告一致的家庭维持治疗方案的患者数量。
