Quality improvement methods improve inhaled corticosteroid prescribing in the emergency department

Andrews, Annie Lintzenich; Russell, W. Scott; Titus, M. Olivia; Braden, Jennifer Brennan; Word, Carolyn; Cochran, Christina; Adams, Sarah J.; Roberts, James R.

doi:10.3109/02770903.2014.911885

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…The latter suggests more emphasis on physician's short-term treatment goals and/or suboptimal prescription filling by patients [ 39 ]. Although reported prescribing behaviour may overestimate real practice patterns, the apparent discrepancy with prescriptions studies may be due in part to the fact that poorly controlled patients as described in the vignettes may represent a small proportion of patients enrolled in drug claim data; alternatively it may reflect evolving practice patterns [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

Ducharme

Lamontagne

Blais

et al. 2016

Canadian Respiratory Journal

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Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by ≥60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians' comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation.

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Section: Discussionmentioning

confidence: 99%

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

Ducharme

Lamontagne

Blais

et al. 2016

Canadian Respiratory Journal

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“…Initial project interventions were developed and implemented with guidance from our key driver diagram and centered around education, monthly directed attending (through presentation and discussion of run chart results and kudos to prescribers at monthly division staff meetings) and resident (through monthly emails with run chart results, kudos to prescribers, and project description to incoming rotating residents) level feedback and the development of an EMR discharge order set that contained an ICS prescribing prompt. (12) The primary change in the transition from high intensity intervention to low intensity intervention phase of the study was to stop monthly directed provider feedback to PED attending physicians. This change began in February 2014.…”

Section: Methodsmentioning

confidence: 99%

“…In 2014 we published the results of our successful Quality Improvement (QI) initiative to increase the rate of ICS prescribing in our Pediatric ED (PED). (12) We increased ICS prescribing rates from a baseline median of 11% to a median of 79%. At the time of publication, we had sustained this rate for 8 consecutive months.…”

Section: Introductionmentioning

confidence: 99%

Inhaled corticosteroid prescribing in a pediatric emergency department: Sustained success and prescription filling rates

et al. 2017

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Objective To determine if ICS prescribing in the pediatric emergency department (PED) can be sustained after transition from intense intervention to low intervention phase, and to determine ICS fill rates. Methods A QI project began in Aug 2012. Results through Feb 2014 were previously published. In Feb 2014 interventions were scaled back to determine the sustainability of QI success. Eligible patients included children age 2–17 seen in the PED for asthma between Feb 2014– Sept 2016. The primary change when moving to the low intervention phase was stopping monthly attending feedback. The primary outcome was the proportion of patients who were prescribed an ICS at time of PED discharge. The secondary objective of this study was to determine the proportion of patients who filled their ICS prescription in the 6 months following ED visit. Results The ICS prescribing goal was 75%. After transition to the low intervention phase, the ICS prescribing rate was maintained at a median of 79% through Sept 2016. ICS fill rate in the first 30 days following ED visit was 89%, although this quickly fell to below 40% for months 2–6. Conclusions ICS prescribing stayed above the goal over a 2.5-year period after transition to a low intervention phase. High ICS fill rates immediately after ED visit have been demonstrated. However, rapid decline in these rates over subsequent months suggests a need for future efforts to focus on long term ICS adherence among children with ED visits for asthma.

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“…However, due to their simplicity and simple rules for detecting non-random patterns and variation over time, the run chart has been described as the 'universal tool' for virtually every improvement project. 11 They have been employed by clinical teams for a wide variety of health care processes such as HIV screening in primary care, 12 for inpatient bronchiolitis, 13 chemotherapy, 14 measuring inpatient harms, 15 central line associated bacteraemia, 16 orthopaedics, 17 acute coronary syndrome, 18 inhaled corticosteroid prescribing, 19 insulin therapy 20 and also by patients. 5,21 At the time of the study, the two PHOs also used run charts to track immunisation and to illustrate progress towards population health priority areas such as giving brief advice for smoking cessation.…”

Section: Discussionmentioning

confidence: 99%

Using run charts for cardiovascular disease risk assessments in general practice

et al. 2016

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1Management recommendations are based on five-year CVD risk stratification, with greater the intensity of lifestyle and medication management recommended for people with higher estimated ABSTRACT IntroductIon: Run charts are quality improvement tools.AIm: To investigate the feasibility and acceptability of run charts displaying weekly cardiovascular disease (CVD) risk assessments in general practice and assess their impact on CVD risk assessments.methods: A controlled non-randomised observational study in nine practices using run charts and nine control practices. We measured the weekly proportion of eligible patients with completed CVD risk assessments for 19 weeks before and after run charts were introduced into intervention practices. A random coefficients model determined changes in CVD risk assessment rates (slope) from pre-to post-intervention by aggregating and comparing intervention and control practices' mean slopes. We interviewed staff in intervention practices about their use of run charts.results: Seven intervention practices used their run chart; six consistently plotting weekly data for >12 weeks and positioning charts in a highly visible place. Staff reported that charts were easy to use, a visual reminder for ongoing team efforts, and useful for measuring progress. There were no significant differences between study groups: the mean difference in pre-to post-run chart slope in the intervention group was 0.03% more CVD risk assessments per week; for the control group the mean difference was 0.07%. The between group difference was 0.04% per week (95% CI: -0.26 to 0.35, P = 0.77).dIscussIon: Run charts are feasible in everyday general practice and support team processes. There were no differences in CVD risk assessment between the two groups, likely due to national targets driving performance at the time of the study.

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Quality improvement methods improve inhaled corticosteroid prescribing in the emergency department

Abstract: This study demonstrates that QI methods can be used to increase inhaled corticosteroid initiation rate at the time of ED discharge and, thus, improve the delivery of preventive asthma care in the acute care setting.

Cited by 11 publications

References 14 publications

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

Inhaled corticosteroid prescribing in a pediatric emergency department: Sustained success and prescription filling rates

Using run charts for cardiovascular disease risk assessments in general practice

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