Development of a Clinical Decision Support Tool to Implement Asthma Management Guidelines in Pediatric Primary Care (Preprint)

Abstract

There is a longstanding gap between national asthma guidelines and their implementation in primary care. Primary care providers (PCPs) endorse numerous provider and practice/clinic-related barriers to providing guidelines-based asthma care. To reduce asthma morbidity in primary care, PCPs need access to tools that facilitate adherence to national guidelines, which can be delivered at the point of care, are minimally burdensome, and fit within the clinic workflow. Clinical decision support (CDS) tools are health information technology (IT) systems that can be housed in the electronic health record (EHR) system.

The current study follows user-centered design principles and describes our formative qualitative work with target stakeholders (i.e., PCPs and IT professionals) to inform our design of an EHR-embedded CDS tool that adheres to recent, significant changes in asthma management guidelines.

We used purposive sampling to recruit three separate subgroups of professionals between (n = 15): 1) PCPs with previous experience using a paper-based CDS tool for asthma management; 2) PCPs without previous experience using CDS tools for asthma management; and 3) healthcare IT professionals. The PCP interview guide focused on their practice, familiarity with national asthma guidelines, and how a CDS tool embedded in the EHR might help them provide guideline-based care. The healthcare IT professional guide included questions on design and implementation processes of CDS tools into the EHR. Qualitative data were audio recorded, transcribed, and then analyzed using an inductive approach to develop themes.

Themes were organized into two domains, current practice and CDS tool development. Themes that emerged from PCPs included descriptions of assessments conducted to make an asthma diagnosis, previous attempts or opportunities to implement updated national asthma guidelines, and how a CDS tool could be implemented using the EHR and fit into current asthma management workflow. Themes that emerged from healthcare IT professionals included processes used to design CDS tools and strategies to collect evidence that indicated a tool’s value to a practice and the broader health system.

In this study, we employed user-centered design principles to guide a qualitative study on perceived barriers and facilitators to a primary care based, EHR-integrated asthma CDS tool. PCPs expressed their interest in adopting an asthma CDS tool that was low burden and efficient but could help them adhere to national asthma guidelines and improve clinic workflow. Similarly, healthcare IT professionals perceived an asthma CDS tool to be useful, if it adhered to EHR design standards. Implementation of a CDS tool to improve adherence of PCPs to recently updated national asthma guidelines could be beneficial in reducing pediatric asthma morbidity.