A Computerized Asthma Management System in the Pediatric Emergency Department
Condition: Asthma
MeSH terms: Asthma; Emergencies
Study type: Interventional

Summary: 
      The primary goal of this study is that the combination of a computerized asthma reminder
      system with implementation of an guideline will increase utilization and adherence of
      guideline-driven care, leading to improved patient outcomes.

      Hypothesis: An automatic, computerized reminder system for detecting asthma patients in the
      pediatric ED will increase guideline adherence compared to paper-based guideline.

      The specific aims of the study are:

      Aim 1: Develop, implement, and integrate the asthma guideline in the ED information system
      infrastructure.

      Aim 2: Evaluate the effect of the asthma detection system combined with the computerized
      guideline versus the asthma detection system combined with the paper-based guideline.
    

Detailed description: 
      Asthma is the leading chronic childhood disease affecting 9 million children (12.5%) under 18
      years of age (1). Asthma exacerbations cause an estimated 14 million missed school days (2)
      and more than 1.8 million emergency department (ED) visits annually (2), and account for >60%
      of asthma-related costs (3). The chronic characteristic of asthma carries a considerable
      economic burden.

      Uncontrolled asthma can lead to exacerbations requiring the patient to seek immediate care,
      frequently in an ED setting. Several asthma guidelines, including the nationally accepted
      guideline from the National Heart, Lung, and Blood Institute (NHLBI), exist to support
      clinicians in providing adequate treatment. Utilization of and adherence with asthma
      guidelines improves patients' clinical care (4, 5). However, guideline adherence remains
      suboptimal. In the ED, early recognition and accurate assessment of the severity of airway
      obstruction and response to therapy are fundamental to the improvement of health for patients
      with asthma. The NHLBI guidelines emphasize early recognition and treatment of asthma
      exacerbations, as well as appropriate treatment stratified by severity.

      Computer applications for patient care can address barriers to optimal medical care. Computer
      systems have improved the use and adherence to practice guidelines, provide clinical alerts
      and reminders, and generate patient-specific treatment recommendations and educational
      material. Implementation of guideline-driven decision support is frequently paper-based or
      computerized. In either form a major barrier remains on the busy clinicians to remember to
      initiate the guideline a process and to embed the guideline tasks in the clinical workflow of
      the care team (5). The proposed study examines the benefits of a novel approach for reminding
      clinicians in an ED setting to use guideline-driven care. The approach will apply a
      workflow-embedded process taking advantage of an advanced information technology
      infrastructure. The informatics approach will include two elements: a) a computerized,
      real-time reminder system, which will automatically detect guideline-eligible patients
      without requiring additional data entry, and b) a computerized, workflow-embedded guideline
      implementation.
    

Intervention name(s): Computerized Asthma Management System
Intervention type(s): Other
Intervention description(s): The intervention group's clinicians will receive prompts via the computerized management system to prompt them for scoring, assessments, and disposition decisions.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: asthma; emergency medicine; medical informatics; computerized reminder systems