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The national guidelines describing best practices for treating and controlling asthma in children span some 300 pages.
This novel-length document offers such a wide array of possible medication choices and treatment options that few pediatricians can keep all that information in their heads.
As a result, many children with asthma do not receive care that lines up with the guidelines. Cincinnati Children’s seek to change that dynamic through better use of electronic data.
A team of software developers under the guidance of Carolyn Kercsmar, MD, director of the Asthma Center at Cincinnati Children’s, worked for five years to create the Asthma TreatSmart decision support tool for pediatricians.
The tool was introduced in summer 2011 to three practices in Greater Cincinnati, with plans to roll it out to 35 more by March 2013. Combined, these 38 groups serve nearly 13,000 children with asthma, including 1,800 defined as high-risk.
This initiative is supported, in part, through Cincinnati Children’s participation in the Beacon grant, a regional effort to improve outcomes through innovations in health information technology sponsored by the federal Department of Health and Human Services.
“This tool helps a physician assess the severity of a child’s asthma, what level of control has been achieved, and offers recommendations for applying treatment,” Kercsmar says. “It distills a highly complex set of treatment guidelines into a quick, real-time reference.”
With asthma accounting for some 2 million office visits a year nationwide and acute respiratory complaints being the No. 1 discharge diagnosis at Cincinnati Children’s, the demand for improved technology is powerful.
“This tool is a way to document, ‘Are your patients doing as well as you think?’” Kercsmar says.
In a perfect world, children with asthma would get all their regular care through a single physician who has developed a rapport with the family. When emergencies occur, they would consistently use the same hospital.
In the real world, families move around. Insurers change. Physicians retire. Kids head off on camping trips. And that means medical records can be scattered all over.
Through the Beacon grant, experts at Cincinnati Children’s are working with several regional partners to assure that all providers have access to the best, most comprehensive information to improve outcomes.
A related goal is to aggregate information so that community-wide trends can be studied, gaps in care can be detected, and improvements can be implemented at a large scale.
Key elements of the project will roll out in 2012, says Keith Mandel, MD, vice president of medical affairs of the physician-hospital organization at Cincinnati Children’s.
As part of this effort, Mid-City Pediatrics and a few other physician practices will soon begin receiving data related to asthma care, including alerts whenever a patient seeks emergency care or gets admitted to an area hospital.
“An ER visit isn’t necessarily a failure of care, but it is a reason to conduct a root cause analysis to understand key contributing factors from the patient and family perspective,” says Camille Graham, MD, president of Mid-City Pediatrics and executive community physician leader at Cincinnati Children’s.
Did the patient really need to go to the hospital? Did the child actually have their medications on hand, or did a prescription go unfilled? Could the case have been handled with a telephone consultation instead of an emergency visit?
By capturing a more complete picture of the care provided to a single person, the new automated alert system could help physicians and families in many ways. Possibilities include more accurately adjusting treatment, identifying families that need help obtaining medications, or spotting patients who could benefit the most from joining a research study.
“The overall goal is to improve care. But to improve care, first you need valid numbers,” Graham says.
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Carolyn Kercsmar, MD.
Keith Mandel, MD.
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