BACKGROUND AND OBJECTIVES Asthma exacerbation is a common and often preventable cause of Emergency Department (ED) utilization. Children eligible for Medicaid are at increased risk of poor asthma control and subsequent ED visits. In 2010, we implemented a multicomponent longitudinal quality improvement project to improve pediatric asthma care for our primary care population, which was 90% Medicaid-eligible. Our goal was to reduce asthma-related ED visits by patients ages 2 to 18 years by 3% annually. METHODS The setting was a multisite large urban high-risk primary care network affiliated with a children's hospital. We implemented 5 sequential interventions within our network of pediatric primary care centers to increase: use of asthma action plans by clinicians, primary care-based Asthma Specialty Clinic visits (extended asthma visits in the main primary care site), use of a standard asthma note at all visits, documentation of the Asthma Control Test, and step-up therapy for children with poorly controlled asthma. RESULTS At baseline in 2010, there were 21.7 asthma-related ED visits per 1000 patients per year. By 2019, asthma-related ED visits decreased to 14.5 per 1000 patients per year, a 33% decrease, with 2 center line shifts over time. We achieved and sustained our goal metrics for 4 of 5 key interventions. CONCLUSIONS We reduced ED utilization for asthma in a large, high-risk pediatric population. The interventions implemented and used over time in this project demonstrate that sustainable outcomes can be achieved in a large network of primary care clinics.

中文翻译：

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旨在减少哮喘急诊就诊的初级保健质量改进项目。


背景和目标 哮喘加重是急诊科 (ED) 使用的常见且通常可以预防的原因。符合医疗补助资格的儿童哮喘控制不佳和随后就诊的风险增加。 2010 年，我们实施了一项多组成部分的纵向质量改进项目，以改善初级保健人群的儿科哮喘护理，其中 90% 的人群符合医疗补助资格。我们的目标是每年将 2 至 18 岁患者因哮喘相关的急诊就诊次数减少 3%。方法 背景是儿童医院附属的多地点大型城市高风险初级保健网络。我们在儿科初级保健中心网络内实施了 5 项连续干预措施，以增加：临床医生对哮喘行动计划的使用、基于初级保健的哮喘专科诊所就诊（在主要初级保健站点延长哮喘就诊时间）、使用标准哮喘记录在所有就诊中，记录哮喘控制测试，以及对哮喘控制不佳的儿童进行升级治疗。结果 2010 年基线时，每年每 1000 名患者中有 21.7 人因哮喘相关就诊。到 2019 年，哮喘相关急诊就诊次数减少至每年每 1000 名患者 14.5 次，下降了 33%，并且随着时间的推移，中心线发生了 2 次移位。我们实现并维持了 5 项关键干预措施中 4 项的目标指标。结论 我们减少了大量高危儿科人群哮喘的急诊室使用率。该项目中长期实施和使用的干预措施表明，大型初级保健诊所网络可以实现可持续的成果。