title: Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System.
abstract: BACKGROUND
  Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes.
  
  
  METHODS
  eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls.
  
  
  RESULTS
  Between December 2012 and September 2014, 5174 patients with asthma (∼10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant.
  
  
  CONCLUSIONS
  This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice.
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC. lindsay.kuhn@carolinashealthcare.org.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kuhn
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Kelly
authors.initials: K
authors.lastname: Reeves
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Yhenneko
authors.initials: Y
authors.lastname: Taylor
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Hazel
authors.initials: H
authors.lastname: Tapp
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Andrew
authors.initials: A
authors.lastname: McWilliams
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gunter
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cleveland
authors.affiliation: From the Department of Family Medicine (LK, KR, HT, AM, MD), Dickson Advanced Analytics (YT, MD), and Department of Pediatrics (AG, JC), Carolinas HealthCare System, Charlotte, NC.
authors.forename: Michael
authors.initials: M
authors.lastname: Dulin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D019033:Delivery of Health Care, Integrated; D018450:Disease Progression; D057286:Electronic Health Records; D005260:Female; D005845:Georgia; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012648:Self Care; D013022:South Carolina; D055815:Young Adult
keywords: Asthma; Clinical Decision Support Systems; Electronic Health Records; Outcomes Assessment