Asthma Clinical Practice Guideline Implementation and Evaluation in a Military Treatment Facility Pediatric Clinic
Asthma is a common chronic disease of childhood, affecting more than six million children (NHLBI, 2007). Several national guidelines regarding asthma diagnosis and treatment are available. Two of the most accepted are the National Heart, Lung, Blood Institute (2007) and the Department of Defense and Veteran's Affairs (DoD/VA, 2009) clinical practice guideline (CPG). These guidelines assist Health Care Providers (HCP's) in delivering the most current and accepted standards of practice for patients with asthma. However, compliance is often difficult for HCPs as well as patients. The purpose of this evidence-based project was to implement the DoD/VA asthma CPG at a Military Treatment Facility pediatric clinic. Compliance with the asthma CPG was evaluated in 5 specific areas: emergency department visits, acute care visits, hospitalization rate, use of a written asthma action plan and prescription of inhaled corticosteroid for any severity of persistent asthma. The Stetler Model of Research Utilization (2001) was used to facilitate this project. After literature review and an organizational assessment, this author utilized a combined approach of provider education and extrinsic tools to implement the CPG. A 3-month retrospective chart review was completed prior to and three months after CPG implementation. The two groups had similar ages, sex, and sponsor status. Following implementation of the CPG, there was a 6% decrease in the percentage of ED visits. However, there was a slight increase in rates of acute care visits and hospitalizations (2% and 6%, respectively). A small (2%) increase was also noted in the use of ICS. Unfortunately, post-CPG implementation data collection coincided with the winter months, which may have been a confounder. There was a larger increase in use of written asthma action plan post-CPG implementation (14 to 44%). Using the z-test of proportions, only the increase in the use of asthma action plan was statistically significant. Although there was not significant improvement in the majority of outcomes measured, the primary goal of this project was implementation of the asthma CPG. No one method of CPG implementation has been proven to be more successful than another method according to the literature. Through the process of this evidence-based practice project, Providers have voiced an increased awareness of the DoD/VA CPG. Although not formally measured, this provides a basis for future in depth study and analysis. This project will be sustained via ongoing process improvement monitoring and reporting.
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