Increasing Routine Asthma Visit Compliance in Pediatric Patients: A Quality Improvement

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Eorgan, Katherine
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Purpose: The purpose of this quality improvement project was to increase the compliance of routine asthma visits within a pediatric primary care clinic in the Omaha metro area.|Background: Asthma is a leading chronic condition in the pediatric population and a main reason for seeking care. While primary care and routine asthma visits are declining, use of emergency rooms and urgent care settings are increasing in the pediatric population. It is estimated that over 50% of the pediatric asthmatic population has uncontrolled asthma with a majority of these patients being of lower socio-economic status and ethnic minorities. Uncontrolled asthma contributes to missed days of school, activity restrictions, decreased quality of life and even mortality. Healthy People 2030 created goals to promote routine asthma care and reduce hospitalizations. The Composite Asthma Severity Index (CASI) is a validated tool and useful strategy for identifying patients’ asthma severity and control.|Sample/Setting: Patients seeking asthma medication refills in a midwestern pediatric primary care clinic.|Methods: CASI scores were completed during routine asthma visits and during medication refill encounters. A CASI score change of +/-2 points prompted the nurse to offer an appointment. Social determinants of health and barriers to accessing care were assessed at 2 different times; during scheduling of routine asthma visits and with medication refills to mitigate the barrier and allow for scheduled care.|Results: Prior to implementation, no show rates were in 17.2% 2019 and 11.8% in 2020. After implementing serial CASI scores and identifying barriers to care the total no show rate for asthma visits was 15.4% of the total population. 13 asthma medication refill encounters were completed during the project. 46% (n=6) of the encounters had a completed CASI tool, with 7% (n=1) depicting a change in CASI score (decrease of 4 points) indicating the need for provider evaluation. 23% (n=3) routine appointments were scheduled during the routine asthma medication refill and 66% (n=2) attended their routine asthma visit during the project’s time-frame. No barriers to care were disclosed during the asthma medication refill encounters or when scheduling an appointment.|Conclusion: Increasing use of the CASI during refill encounters and identifying barriers to care did not reduce the number of no-show visits within the clinic during the project’s limited time-frame.
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