92 - Increasing asthma control test completion rates across four pediatric multispecialty divisions in an academic medical center

Publication Number: 4090.92

Katie M. Catalano, Boston Children's Hospital, Boston, MA, United States; Maria Biancarelli, Boston Children's Hospital, SOUTH WALPOLE, MA, United States; Erin Antonellis, Boston Children's Hospital, Boston, MA, United States; Linda Haynes, Boston Children's Hospital, Boxford, MA, United States; Sirine Benali, Boston Children's Hospital, Boston, MA, United States; Rainer Petrea, Boston Children's Hospital, Belmont, MA, United States; Alexandra Epee-Bounya, Boston Children's Hospital, Boston, MA, United States; Sarah P. Justvig Nelson, Boston Children's Hospital, Boston, MA, United States; Leora Levitt, Boston Children's Hospital, Sharon, MA, United States; Kelly A. Robinson, Boston Children's Hospital, Weymouth, MA, United States; Rebecca F. O'Brien, Boston Children's Hospital, Boston, MA, United States; Sheila Petrosino, Boston Children's Hospital, Boston, MA, United States; Vivian Tran, Boston Children's Hospital, Boston, MA, United States; Jenessa McCabe, Boston Children's Hospital, Lowell, MA, United States; Natalie Davison, Boston Children's Hospital, Natick, MA, United States; Madeline Chiujdea, Boston Children's Hospital, Thornton, NH, United States; Michelle Lyden, Boston Children's Hospital, Boston, MA, United States; Anthony Dekermanji, Boston Children's Hospital, Boston, MA, United States; Brittany Esty, Boston Children's Hospital, Boston, MA, United States; Tregony Simoneau, Boston Children's Hospital, Boston, MA, United States

Background: National asthma guidelines recommend the use of a standardized, validated measure of asthma control at every visit. The Asthma Control Test (ACT) assesses a patient's asthma control over the past four weeks and is indicative of exacerbation risk. Clinicians face challenges with creating a reliable process to complete ACTs for patients with asthma.

Objective: To increase ACT completion rates across four multispecialty divisions from 34% to 75% by March 31, 2026; to have at least one clinic representative attend each learning session.

Design/Methods: Using the Institute for Healthcare Improvement Breakthrough Series Collaborative Model, the team launched a learning collaborative in June 2025 with participation from four ambulatory multispecialty divisions: Adolescent Medicine, Allergy, Primary Care (3 sites), and Pulmonary Medicine. The nine-month collaborative entails four quarterly learning sessions about ACT completion rates and score use (Figure 1). The session content includes education, data review, and sharing successful strategies. A process map and fishbone diagram were developed to identify barriers to ACT completion. The team identified the primary drivers to ACT completion using a driver diagram (Figure 2) and prioritized interventions using an impact-effort matrix. A group Plan-Do-Study-Act (PDSA) cycle initiated a structural intervention within the electronic health record to auto-assign the ACT as a pre-visit patient questionnaire, delivered via the patient portal in the patient's preferred language. Clinics also launched local PDSAs with ideal state contingency plans for ACTs not completed prior to visits. Lessons learned were shared between clinics. Statistical process control p' and p charts were used to analyze our outcome measure of ACT completion rates.

Results: Statistical process control rules demonstrated a significant mean shift in the ACT rate in the desired direction from 34% to 45% (Figure 3). Clinics who began local PDSA cycles showed significant improvement compared to those who did not. At least one clinic representative attended each learning session thus far.

Conclusion(s): ACT completion rates improved with the launch of a group PDSA cycle that was adopted and interdivisional learning collaborative with local PDSAs during action periods. The collaborative structure fostered sharing of strategies across divisions, promoted staff engagement at monthly meetings, and emphasized the importance of monthly data sharing to drive quality improvement. Our collaborative will continue through March 2026 with plans to improve ACT completion rates for patients who speak Spanish.

ACT Learning Collaborative Timeline and Plan


Driver Diagram- ACT Completion


All Clinics (Adolescent Medicine, Allergy, CHPCC, MEHC, Pulmonary Medicine & Weymouth Primary Care) Percent of patients ≥ 4- 21 years old with a diagnosis of asthma who have a completed ACT survey from visit (Oct 2022- Oct 2025)
P' (P prime) statistical process control chart