Interprofessional Collaboration for Pediatric Asthma Care: Improving Care Through Collaborative Quality Improvement Work

Asthma is the most common chronic disease of childhood, affecting more than 5.5 million children in the United States (Centers for Disease Control and Prevention [CDC], 2017; CDC, 2019a). Over half of children diagnosed with asthma are classified as having uncontrolled disease, leading to emergency department visits, hospitalizations, and missed school days (CDC, 2015; CDC, 2019b; CDC, 2019c). Adherence to asthma guidelines leads to reduction in asthma morbidity (NAEPP, 2007).
In one North Carolina pediatric primary care clinic, providers expressed a desire to improve the clinic’s asthma care. An interprofessional quality improvement (QI) team was formed, which aimed to increase the percentage of providers following the recommendations established in the NHLBI asthma guidelines by (1) increasing the percentage of providers making specific asthma diagnoses; (2) increasing the percentage of providers prescribing appropriate asthma medications; and (3) increasing the percentage of providers introducing patients to pediatric-specific asthma apps as part of patient education (NAEPP, 2007; NAEPPCC EPWG, 2020).
The interprofessional QI team consisted of a Doctor of Nursing Practice student, a Pediatric Nurse Practitioner, the Medical Director of the clinic and Pediatrician, four Resident Physicians, a Medical Intern, a Masters of Science in Nursing student, and a Registered Nurse. The Institute for Healthcare Improvement’s Model for Improvement was used to guide the project. The QI team employed several QI strategies including academic detailing, audit and feedback, use of reminders and printed materials, and decision support through technology-based solutions during Plan-Do-Study-Act cycles. The methods of analysis were the use of control charts following the Shewhart rules and the calculation of two-tailed two-proportion z-tests.
The percentage of pediatric asthma patients with a specific asthma diagnosis improved from 60% in January of 2021 to 99% in April of 2021. The percentage of patients with appropriate asthma medications prescribed improved from 51% in April of 2020 to 78% in April of 2021. The percentage of providers who recommended an asthma app as part of patient education increased from 0% in June of 2021 to 50% by December 2021. These are all statistically and clinically significant improvements.
The interprofessional nature of this QI initiative was key to the success of the project. Because representatives from multiple disciplines were involved as leaders on the QI team, many audiences at the clinic were able to be reached, influenced, and engaged in the project. Interprofessional collaboration should be considered by those undertaking QI initiatives in similar settings.