title: Putting guidelines into practice: improving documentation of pediatric asthma management using a decision-making tool.
abstract: OBJECTIVE
  To assess improvement in documentation of asthma indicators using the Asthma Toolbox, an asthma decision-making tool developed in accord with National Asthma Education and Prevention Program guidelines.
  
  
  METHODS
  Retrospective medical record review using cross-sectional, independent, random samples. Reviews were conducted for 1-year periods before and after implementation and after revision reflecting 2007 guideline modifications.
  
  
  METHODS
  Two inner-city, federally qualified health center programs providing pediatric primary care to housed and homeless populations.
  
  
  METHODS
  A total of 1246 patients aged 6 months to 18 years with at least 1 asthma visit to a community health center using paper records (n = 600) or a mobile medical program serving family homeless shelters using an electronic health record (EHR; n = 646).
  
  
  METHODS
  Implementation of the Asthma Toolbox incorporated into paper encounter forms and embedded in the EHR to guide providers (ie, physicians and nurse practitioners) through pediatric asthma assessment and management.
  
  
  METHODS
  Documentation of a subset of asthma severity/control measures, emergency department visits, hospitalizations, and percentage of persistent asthmatic patients prescribed controller medications.
  
  
  RESULTS
  Documentation of each asthma indicator increased significantly after implementation (χ(2) tests; P < .001 all comparisons) for both programs. Documentation of severity/control increased from 25.5% to 77.5% in paper records and from 11.7% to 85.1% in the EHR (P < .001). Increases were sustained after Asthma Toolbox revision for all indicators. The percentage of patients with persistent/uncontrolled asthma prescribed controller medications reached 96% to 97% in both programs.
  
  
  CONCLUSIONS
  Use of the Asthma Toolbox, an asthma decision-making tool, significantly increased documentation of pediatric asthma management among providers working in high-disparity, urban primary care settings.
authors.affiliation: Community Pediatric Programs, Montefiore Medical Center, 853 Longwood Ave., Bronx, NY 10459, USA. ashapiro@montefiore.org
authors.forename: Alan
authors.initials: A
authors.lastname: Shapiro
authors.forename: Delaney
authors.initials: D
authors.lastname: Gracy
authors.forename: Wendy
authors.initials: W
authors.lastname: Quinones
authors.forename: Jo
authors.initials: J
authors.lastname: Applebaum
authors.forename: Ariel
authors.initials: A
authors.lastname: Sarmiento
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004282:Documentation / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D017749:Total Quality Management; D016896:Treatment Outcome; D014481:United States