Improving Inhaled Coricosteroid Prescribing at Discharge for Children with Asthma: A Quality Improvement Initiative Based on GINA Guidelines

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Publication Date

7-23-2025

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Presentation: 1:27:56

Abstract

Asthma remains one of the most prevalent chronic pediatric conditions in the United States, causing significant morbidity and healthcare resource utilization despite established guidelines. Hospital discharge represents a crucial, yet underutilized opportunity for optimizing asthma management. This quality improvement (QI) initiative aimed to increase the proportion of medically uncomplicated pediatric patients discharged from a hospital service with an inhaled corticosteroid (ICS) prescription from a baseline of 58% to greater than 80% within one year. The interventions included educational sessions for providers, implementation of a standardized electronic health record documentation template, creation of an accessible digital toolkit summarizing the 2024 Global Initiative for Asthma (GINA) guidelines, and dissemination of badge-sized cards for quick provider reference. Data were collected retrospectively during the baseline period from January 2023 to May 2024 and during the intervention period from June 2024 to May 2025. Monthly chart reviews and statistical process control were employed to assess process shift variation. Provider perceptions regarding ease of guideline access and efficiency in documentation were assessed via surveys. Results demonstrated a positive process shift in ICS prescribing for patients over five years, increasing from 66% at baseline for this age group to 85% post-intervention, reflecting reduced reliance on short acting beta-agonist (SABA)-only treatment. Documentation completeness also increased, from 35% to 64%, facilitating more accurate assessment of asthma severity. However, no shift was observed in the use of the unspecified asthma diagnosis. Provider surveys indicated improved perceptions of efficiency without increased perceived difficulty in accessing guidelines. Limitations include single-center design, limited survey responses, and potential confounding by provider experience. The interventions proved effective in enhancing guideline adherence and documentation practices and demonstrated high potential for sustainability related to minimal cost and embedding interventions into clinical workflows. Further study should evaluate long-term adherence and clinical outcomes.

Language

English

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