Article Figures & Data
Figures
- Figure 1.
Electronic asthma action plan decision support tool (eAAP) development phases. EHR, electronic health record.
- Figure 2.
Screenshot of the electronic asthma action plan decision support tool (eAAP) in the electronic health record.
- Figure 3.
Screenshot of the electronic asthma action plan decision support tool (eAAP) patient handout for self-management.
- Figure 4.
Electronic asthma action plan decision support tool (eAAP) usage per month across the health care system's primary care outpatient network. From December 2012 through September 2014, a total of 6484 eAAPs were completed. The tool was used at 30 to 40 outpatient practices each month by October 2013.
Tables
Team Members (n) Credentials/Type (n) Role Descriptions Physician leader (1) MD, PhD (1) Oversaw the development and implementation of the eAAP; principal investigator of research project that partially funded the work Project manager (2) MBA, PT (1) Coordinated team to meet goals and keep the project on track MHS, PA-C (1) Content experts (2) MHS, PA-C (1) Incorporated the 2007 NHLBI asthma guidelines into the eAAP's recommended stepwise treatment options BSN, RN (1) Clinical advisors (8) MD (6) Provided feedback regarding usability, functionality, and accessibility with regard to patient care and work flow RRT (1) MSN, RN (1) Programmers (5) RN (1) Built the platform of the program into the EHR BA/BS (5) Information services (5) BBA, RRT (1) Handled technical challenges blending clinical and application areas BSN, RN (3) BS (1) Quality specialists (5) MHS, PA-C (1) Ensured the integration of appropriate care measures into the tool; team of nurses supported its use in the field BSN, RN (2) MHA, CPHQ (1) BS, RRT (1) Administrators (2) MSN, RN (1) Supported system-wide expansion BSN, RN (1) Evaluation support (3) PhD (2) Provided research and data analysis for outcomes measures MSPH (1) Pilot sites (5) Pediatrics (2) Provided initial feedback during the experimental phase before the system-wide launch Family medicine (2) Teen specialty (1) eAAP, electronic asthma action plan decision support tool; EHR, electronic health record; NHLBI, National Heart, Lung, and Blood Institute.
- Table 2. Demographic Characteristics for the Sample of Patients Receiving the Electronic Asthma Action Plan Decision Support Tool (N = 5174)
Children (0–17 Years) (n = 4259; 82%) Adults (≥18 Years) (n = 915; 18%) Mean age (years) 9.3 40.0 Gender (%) Female 37.7 69.6 Male 62.3 30.4 Race/ethnicity (%) African American 34.0 42.3 Caucasian 34.0 41.4 Hispanic/Latino 8.4 3.9 Asian 1.3 0.2 Native American 0.1 0.3 Multiracial 1.5 0.1 Other race 3.4 1.9 Missing 17.3 9.9 Insurance (%) Commercial 56.0 53.4 Medicare N/A 15.5 Medicaid 41.1 22.2 Self-pay/charity 0.0 0.3 Other/unknown 2.9 8.5 N/A, not applicable.
- Table 3. Data Frequencies in the Matched Sample of Patients Receiving the Electronic Asthma Action Plan Decision Support Tool
Children Adults eAAP (n = 2783) Control (n = 2783) eAAP (n = 892) Control (n = 892) Mean age, years (SD) 9.3 (4.3) 9.3 (4.6) 40.1 (17.1) 40.2 (16.6) Race/ethnicity, n (%) African American 1,044 (37.5) 1,063 (38.2) 377 (42.3) 373 (41.8) American Indian or Alaska Native 15 (0.5) 11 (0.4) 8 (0.9) 8 (0.9) Asian 35 (1.3) 33 (1.2) 2 (0.2) 0 Caucasian 1,220 (43.8) 1,219 (43.8) 377 (42.3) 404 (45.3) Hispanic 20 (0.7) 21 (0.8) 2 (0.2) 1 (0.1) Other 187 (6.7) 184 (6.6) 39 (4.4) 36 (4.0) Unknown 262 (9.4) 252 (9.1) 87 (9.8) 70 (7.8) Insurance category, n (%) Charity 2 (0.1) 1 (0) 2 (0.2) 2 (0.2) Commercial 1,452 (52.2) 1,432 (51.5) 488 (54.7) 513 (57.5) Medicare Medicaid 1,247 (44.8) 1,260 (45.3) 202 (22.6) 180 (20.2) Other 38 (1.4) 41 (1.5) 8 (0.9) 10 (1.1) Self-pay 1 (0.1) 1 (0.1) 1 (0.1) Unknown 44 (1.6) 49 (1.8) 49 (5.5) 48 (5.4) Gender, n (%) Female 1,091 (39.2) 1,111 (39.9) 620 (69.5) 622 (69.7) Male 1,692 (60.8) 1,672 (60.1) 272 (30.5) 270 (30.3) ED visit in prior 12 months, n (%) 132 (4.7) 127 (4.6) 40 (4.5) 41 (4.6) Hospitalization in prior 12 months, n (%) 40 (1.4) 45 (1.6) 4 (0.4) 3 (0.3) Outpatient oral steroid in prior 12 months, n (%) 716 (25.7) 803 (28.9) 181 (20.3) 159 (17.8) Follow-up time, n (%) 3 months 184 (20.6) 226 (25.3) 373 (13.4) 494 (17.8) 6 months 392 (43.9) 374 (41.9) 931 (33.5) 780 (28.0) 12 months 316 (35.4) 292 (32.7) 1,479 (53.1) 1,509 (54.2) eAAP, electronic asthma action plan decision support tool; ED, emergency department; SD, standard deviation.
- Table 4. Acute Asthma Outcome Frequencies in the Matched Sample of Patients Receiving the Electronic Asthma Action Plan Decision Support Tool
Outcomes by Follow-up Time Children Adults eAAP (n = 2783) Control (n = 2783) eAAP (n = 892) Control (n = 892) ED visit, n (%) 3 months after 31 (1.1) 26 (0.9) 14 (1.6) 10 (1.1) 6 months after 56 (2.0) 53 (1.9) 20 (2.2) 18 (2.0) 12 months after 89 (3.2) 84 (3.0) 29 (3.3) 23 (2.6) Hospitalization, n (%) 3 months after 6 (0.2) 11 (0.4) 2 (0.2) 1 (0.1) 6 months after 12 (0.4) 15 (0.5) 3 (0.3) 4 (0.4) 12 months after 16 (0.6) 18 (0.6) 6 (0.7) 4 (0.4) Outpatient oral steroid, n (%) 3 months after 162 (5.8) 223 (8.0) 62 (7.0) 76 (8.5) 6 months after 237 (8.5) 297 (10.7) 88 (9.9) 93 (10.4) 12 months after 219 (7.9) 311 (11.2) 60 (6.7) 60 (6.7) Any exacerbation, n (%) 3 months after 194 (7.0) 250 (9.0) 76 (8.5) 84 (9.4) 6 months after 282 (10.1) 329 (11.8) 105 (11.8) 107 (12.0) 12 months after 261 (9.4) 344 (12.4) 76 (8.5) 70 (7.8)* ↵* Counts for outcomes 3, 6, and 12 months after the intervention include only patients with enough follow-up to capture those outcomes.
eAAP, electronic asthma action plan decision support tool; ED, emergency department.
- Table 5. Odds Ratios Comparing the Odds of Acute Asthma Outcome Events Among Recipients of the Electronic Asthma Action Plan Decision Support Tool Versus Controls
Outcomes by Follow-up Time Children Adults Odds Ratio (95% CI) P Value Odds Ratio (95% CI) P Value ED visit 3 months after 1.19 (0.17–2.00) .501 1.41 (0.62–3.20) .416 6 months after 1.03 (0.69–1.55) .869 1.14 (0.57–2.30) .709 12 months after 1.00 (0.67–1.49) .998 1.53 (0.79–2.94) .207 Hospitalization 3 months after 0.54 (0.20–1.48) .232 2.00 (0.18–22.16) .571 6 months after 1.05 (0.43–2.60) .908 0.23 (0.03–2.11) .195 12 months after 1.17 (0.42–3.23) .765 0.61 (0.10–3.71) .594 Outpatient oral steroid 3 months after 0.71 (0.58–0.87) .001 0.80 (0.57–1.13) .209 6 months after 0.73 (0.61–0.88) <.001 0.88 (0.64–1.20) .402 12 months after 0.67 (0.56–0.81) <.001 0.91 (0.62–1.35) .652 Any exacerbation 3 months after 0.76 (0.63–0.92) .005 0.90 (0.65–1.24) .502 6 months after 0.79 (0.67–0.94) .006 0.91 (0.68–1.22) .592 12 months after 0.73 (0.61–0.87) <.001 1.02 (0.71–1.45) .923 CI, confidence interval; ED, emergency department.
- Table 6. Acute Asthma Outcomes Among Patients Receiving the Electronic Asthma Action Plan Decision Support Tool by Time Since First Use of the Tool
Outcomes Follow-up Time 3 Months before 3 Months after 6 Months before 6 Months after 12 Months before 12 Months after Children, n (%) 3 Months (n = 4,259) 6 Months (n = 3,358) 12 Months (n = 1,925) ED visit 72 (1.7) 44 (1.0)* 85 (2.5) 57 (1.7)* 93 (4.8) 55 (2.9)† Hospitalization 16 (0.4) 8 (0.2)‡ 21 (0.6) 12 (0.4) 18 (0.9) 9 (0.5)‡ Outpatient oral steroid 467 (11.0) 232 (5.4)† 510 (15.2) 303 (9.0)† 413 (21.5) 273 (14.2)† Any exacerbation 537 (12.6) 277 (6.5)† 585 (17.4) 357 (10.6)† 484 (25.1) 319 (16.6)† Adults, n (%) 3 Months (n = 915) 6 Months (n = 717) 12 Months (n = 316) ED visit 17 (1.9) 15 (1.6) 19 (2.7) 17 (2.4) 19 (6.0) 19 (6.0) Hospitalization 1 (0.1) 2 (0.2) 1 (0.1) 1 (0.1) 3 (1.0) 2 (0.6) Outpatient oral steroid 106 (11.6) 63 (6.9)† 98 (13.7) 89 (12.4) 56 (17.7) 60 (19.0) Any exacerbation 117 (12.8) 78 (8.5)* 112 (15.6) 106 (14.8) 70 (22.2) 76 (24.1)
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