Improving Asthma Control Test completion rates across a multi-site pediatric pulmonary clinic network: a quality improvement initiative

Abstract

Objective

Assessing asthma control is an essential part of the outpatient management of children with asthma and can be performed through validated questionnaires such as the Asthma Control Test (ACT). Systematic approaches to incorporating the ACT in outpatient visits are often lacking, contributing to inconsistent completion rates. We conducted a quality improvement initiative to increase the proportion of visits where the ACT is completed for children with asthma in our multi-site pediatric pulmonary clinic network.

Methods

We developed an intervention of sending the ACT questionnaire to patients and caregivers through the electronic patient portal to complete prior to their visits. This strategy was first piloted at one clinic beginning in July 2020 and then expanded to 5 other clinics in the network in October 2020. Our outcome measure was average monthly proportion of visits with a completed ACT, tracked using statistical process control charts. The process measure was method of ACT completion tracked using run charts.

Results

At the pilot clinic, average monthly completion rate rose within 3 months of the intervention from 27% to 72% and was sustained more than 22 months. Completion across all clinics increased from 57% pre-intervention to 76% post-intervention. Importantly, the intervention did not rely on clinic staff to administer the questionnaire and did not interfere with existing clinic flow.

Conclusion

An intervention of delivering the ACT electronically to patients and caregivers for completion prior to visits led to a rapid and sustained improvement in ACT completion rates across a large, pediatric pulmonary clinic network.

Keywords:

• Pediatric pulmonary
• pulmonology
• Asthma Control Test
• electronic patient portal
• patient-reported outcome

Authors’ contributions

JHL conceptualized and designed the initial project as team leader and clinical content expert of the QI project. EH and JSM contributed to the assessment and evaluation of the project as QI experts and advisors. LRY and JA provided support and oversight for the initiative as project sponsors. JHL supervised the implementation of the initiative through the intervention cycles. JHL analyzed the data. BR assisted in data analysis and construction of our SPC charts. JHL drafted the manuscript in its entirety. All authors reviewed the manuscript critically for important intellectual content.

Disclosure statement

LRY reports the following outside the current manuscript: consulting fees from Boehringer Ingelheim for role on pediatric interstitial lung disease advisory board and royalties from UpToDate. JSM reports receiving royalties for her role as associate editor for the journal, BMJ Quality and Safety. The other authors report there are no competing interests to declare.

Additional information

Funding

LRY K24HL143281.