Health Information Technology

Decision support in the electronic record improves asthma care

National Asthma Education and Prevention Program (NAEPP) guidelines, developed by the National Heart, Lung, and Blood Institute, inform clinicians about the best practices in asthma care and management. Despite the availability of these guidelines, physicians do not always adhere to them. Providing clinical decision support (CDS) as part of electronic health records (EHRs) improves adherence to the NAEPP guidelines, particularly when used at the point of care, finds a new study.

For the 1-year study, researchers used 12 primary care sites at both urban and suburban locations, where children with asthma were seen on a regular basis. Prior to the study, each practice engaged in an educational program on asthma management. The 12 sites then received an asthma control tool as part of their EHR system. Six of the 12 practices had CDS alerts imbedded in the EHR. These alerts were based on NAEPP guidelines and designed to guide clinicians to the various asthma tools built into the system.

The researchers found a significant increase in controller-medication prescriptions (often used to prevent asthma episodes) in urban practices receiving the CDS intervention (7 percent) compared with urban practices without alerts (1 percent). There was also an increase in the use of asthma care plans in suburban practices with the intervention (14 percent) compared with suburban practices without the intervention (11 percent). The use of spirometry (to determine lung function/capacity and treatment effects) increased over time in both suburban (from 8 to 14 percent) and urban practices (from 15 to 24 percent). Spirometry declined in the nonintervention suburban group from 8 to 1 percent. Given these findings, the researchers suggest that CDS embedded in the EHR may shorten the time period between clinicians accepting asthma guidelines and actually implementing them in their practices. The study was supported in part by the Agency for Healthcare Research and Quality (HS14873).

See "Electronic health record-based decision support to improve asthma care: A cluster-randomized trial," by Louis M. Bell, M.D., Robert Grundmeier, M.D., Russell Localio, Ph.D., and others in the April 2010 Pediatrics 125(4), pp. e770-e777.

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