Date of Award

Spring 5-21-2016

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Jonathon Mack, PhD, APRN

Second Advisor

Kathy James, PhD, APRN

Abstract

ABSTRACT

Experts in asthma care globally recommend screening for asthma control in all patients with asthma through the use of an evidence-based tool. This project embedded the Asthma Control Test (ACT) in the electronic health record to determine if screening for control would change compared to standard care.

Methods

An electronic template of the ACT was embedded in the electronic health record system for a community faith-based family medicine clinic. All patients 12 years and older with a previous diagnosis of asthma were included in this project. These patients were screened for asthma control using the template at every appointment. The template generated a numerical score up to 25. A score of 19 or less was used to identify asthma patients with poor control of their asthma. A retrospective chart review was performed on the same patient population who presented during the same time frame in 2014. The charts were reviewed for usual screening practices, which included a mention of asthma symptoms in the history of present illness or auscultation of breath sounds during the physical examination.

Results

Screening for asthma control improved from 55% in 2014 to 89% in 2015. Of all the patients screened, 30% scored 19 or less indicating of poor control. Of the poorly controlled patients with asthma, 88% did not present to the clinic for concerns of asthma related symptoms.

Discussion

The embedding of an electronic template improved asthma screening for control rates by 34%. The Asthma Control Test identified poorly controlled patients with asthma despite the patient’s perception of asthma control. This screening allows providers a rescue opportunity to provide medical intervention before a worsening of asthma leads to an emergency department visit or hospital admission. The Physician Quality Reporting System recognizes screening for asthma control as the 2016 Quality metric #398.

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