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Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System.
J Am Board Fam Med. 2015 May-Jun; 28(3):382-93.JA

Abstract

INTRODUCTION

Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes.

METHODS

eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls.

RESULTS

Between December 2012 and September 2014, 5174 patients with asthma (∼10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant.

CONCLUSIONS

This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice.

Authors+Show Affiliations

From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC. lindsay.kuhn@carolinashealthcare.org.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25957371

Citation

Kuhn, Lindsay, et al. "Planning for Action: the Impact of an Asthma Action Plan Decision Support Tool Integrated Into an Electronic Health Record (EHR) at a Large Health Care System." Journal of the American Board of Family Medicine : JABFM, vol. 28, no. 3, 2015, pp. 382-93.
Kuhn L, Reeves K, Taylor Y, et al. Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System. J Am Board Fam Med. 2015;28(3):382-93.
Kuhn, L., Reeves, K., Taylor, Y., Tapp, H., McWilliams, A., Gunter, A., Cleveland, J., & Dulin, M. (2015). Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System. Journal of the American Board of Family Medicine : JABFM, 28(3), 382-93. https://doi.org/10.3122/jabfm.2015.03.140248
Kuhn L, et al. Planning for Action: the Impact of an Asthma Action Plan Decision Support Tool Integrated Into an Electronic Health Record (EHR) at a Large Health Care System. J Am Board Fam Med. 2015 May-Jun;28(3):382-93. PubMed PMID: 25957371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System. AU - Kuhn,Lindsay, AU - Reeves,Kelly, AU - Taylor,Yhenneko, AU - Tapp,Hazel, AU - McWilliams,Andrew, AU - Gunter,Andrew, AU - Cleveland,Jeffrey, AU - Dulin,Michael, PY - 2015/5/10/entrez PY - 2015/5/10/pubmed PY - 2016/2/2/medline KW - Asthma KW - Clinical Decision Support Systems KW - Electronic Health Records KW - Outcomes Assessment SP - 382 EP - 93 JF - Journal of the American Board of Family Medicine : JABFM JO - J Am Board Fam Med VL - 28 IS - 3 N2 - INTRODUCTION: Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes. METHODS: eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls. RESULTS: Between December 2012 and September 2014, 5174 patients with asthma (∼10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant. CONCLUSIONS: This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice. SN - 1558-7118 UR - https://www.unboundmedicine.com/medline/citation/25957371/Planning_for_Action:_The_Impact_of_an_Asthma_Action_Plan_Decision_Support_Tool_Integrated_into_an_Electronic_Health_Record__EHR__at_a_Large_Health_Care_System_ L2 - http://www.jabfm.org/cgi/pmidlookup?view=long&amp;pmid=25957371 DB - PRIME DP - Unbound Medicine ER -