UCLA

The National Asthma Education and Prevention Program (NAEPP) was established in 1991, with the goal to address the growing and significant national health problem of asthma. The NAEPP was last updated in 2007. CHOC Children’s (CHOC) in Orange County, California integrated an Asthma Registry into the electronic medical record (EMR) in 2015 to improve provider adherence to the NAEPP guidelines. Method: A serial cross-sectional design was used to compare change in provider management of asthma patients before an Asthma Registry with NAEPP guidelines was integrated into the EMR to after integration into the EMR. Four variables (Asthma Control Test [ACT], Asthma Action Plan [AAP], inhaled corticosteroids [ICS] and spacers) were evaluated pre-integration (2014) and compared to post-integration (2018) of the Asthma Registry. Using 2018 data, the outcomes of hospital admission, emergency department (ED) and outpatient visits with the diagnosis of asthma exacerbation were compared between the Children’s Medical Group (CMG) and the non-CMG of CHOC Health Alliance. Results: In 2018, patients were more likely to receive an ACT, (OR = 14.95, 95% CI 12.67, 17.65, p < .001), AAP, (OR = 12.70, 95% CI 11.10, 14.54, p < .001), ICS (OR =1.85, 95% CI 8.52, 14.54, p < .001) and spacer (OR= 1.45, 95% CI 1.31, <2e-16, p < .001) compared to those in 2014. In 2018, CMG patients had more asthma exacerbations than non-CMG patients (OR = 1.130, 95% CI 1.049, 1.217, p = .01). When the visit location was analyzed, only ED visits had a significant difference: patients in the CMG group were 1.35 times more like than the non-CMG to have an ED visit (95% CI 1.236, 1.476, p < .001). The increased asthma exacerbations in the CMG patients may be related to the population. The CMG group was 76.4% Hispanic and the non-CMG group was 66.9% Hispanic (2[1] = 39.71, p < .001). Hispanics have been reported to have a higher rate of low health literacy than their white counterparts (Valerio, George, Liu, Osakwe, & Bruzzese, 2018). Conclusion: The integration of the Asthma Registry into the EMR was shown to be an effective intervention to increase provider adherence to the NAEPP guidelines, but ongoing monitoring and education are needed to promote and maintain the behavioral change.