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Impact of an EMR Documentation Template as Clinical Decision Support for Outpatient Asthma Management FREE TO VIEW

Mark Millard, MD; Elisa Priest, DrPH; Louann Cole, MHA; Rich Mularski, MD; Brian Hazlehurst, PhD; Andrew Masica, MD
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Baylor Health Care System, Addison, TX

Chest. 2013;144(4_MeetingAbstracts):68A. doi:10.1378/chest.1703596
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SESSION TITLE: Asthma Diagnosis & Evaluation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM

PURPOSE: As a component of a larger collaborative project being conducted by the Comparative Effectiveness Research Hub (CER-HUB), we evaluated impacts of an asthma specific documentation template embedded into the electronic medical record (EMR) at one study site on measures of asthma control and medication therapy adjustment compared to other study sites without this decision support.

METHODS: The population included patients at each of six CER-HUB sites age 14 years or older who met modified HEDIS criteria for persistent asthma between 2006-2010. We developed data extraction algorithms for determining asthma control in the study site EMRs based on elements in the NHLBI Expert Panel Report-3. 240 patients at each site (sampled randomly) were assessed for asthma control and changes in medications. One site had an asthma EMR documentation template with queries relating to rescue inhaler use and symptom frequency.

RESULTS: 1440 unique asthma patients underwent medical record abstraction (240 patients at the site with the documentation template). The percentage of patients classified as having an “out-of-control” asthma event was significantly higher at the site with structured note (91.3% vs. overall site average of 68.8%, p<0.001). For patients identified as having an out-of-control event, capture of specific symptoms (e.g., nocturnal awakening > 2 times weekly, 43.8 % vs. 25.3%, p<0.01) and frequency of medication change (68.5% vs. 41.4%, p<0.001) were also significantly higher at the site using a documentation template compared to the overall average.

CONCLUSIONS: We observed that a site with a structured EMR template focused on asthma control reported a higher percentage of patients with out-of-control events, and in the out-of-control subset, better characterization of asthma symptoms and increased medication changes compared to sites without the structured note. It is unlikely that these substantial differences are attributable solely to population characteristics or variability in asthma epidemiology between the sites.

CLINICAL IMPLICATIONS: EMR documentation templates appear to be useful clinical decision support in asthma, particularly in identifying uncontrolled disease and prompting providers to modify therapy.

DISCLOSURE: The following authors have nothing to disclose: Mark Millard, Elisa Priest, Louann Cole, Rich Mularski, Brian Hazlehurst, Andrew Masica

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