Improving Asthma Guideline Implementation in Hospital Medicine (ImAGINE): A Single-site Improvement Initiative.

INTRODUCTION

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.

METHODS

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.

RESULTS

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%.

CONCLUSIONS

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.