195 - Implementation of a New Asthma Medication Refill Workflow and Team Approach to Improve Pediatric Optimal Asthma Control in a Pediatric Primary Care Practice

Publication Number: 3187.195

Lourdes M. Valdez, Mayo Clinic Children's Center, Rochester, MN, United States; McWilliams Deborah, Mayo Clinic, Rochester, MN, United States; Leslie Kummer, Mayo Clinic Children's Center, Rochester, MN, United States; Patricia Berntson, Mayo Clinic Children's Center, Elko New Market, MN, United States; Tammy L. Schmit, Mayo Clinic, Rollingstone, MN, United States; Robert M.. Jacobson, Mayo Clinic Children's Center, Rochester, MN, United States; Anna Kellund, Mayo Clinic Children's Center, Rochester, MN, United States; Angie Bicknese, Mayo Clinic Children's Center, Chatfield, MN, United States; Saraphia Magill, Mayo Clinic Children's Center, Rochester, MN, United States; Chung Wi, Mayo Clinic, Rochester, MN, United States

Background: Minnesota Community Measurement (MNCM) defines Optimal Asthma Control (OAC) as an Asthma Control Test (ACT™) score ≥20 and fewer than two asthma-related emergency department (ED) visits and/or hospitalizations in the past 12 months. Our pediatric practice historically failed to meet the MNCM target of 88% OAC. Contributing factors included infrequent patient touchpoints and challenges posed by social determinants of health (SDOH). We hypothesized that engaging patients during asthma medication refill requests-an underused contact point-could improve OAC through an interdisciplinary workflow.

Objective: To increase the proportion of patients aged 5-17 years with asthma achieving OAC by 10% (from 71% to 81%) by September 2024, without worsening SDOH-related disparities.

Design/Methods: Methodology for Quality Improvement (QI): DMAIC (Define, Measure, Analyze, Improve, Control). Fishbone tool was used during the analyze phase by the multidisciplinary QI team involved in the project (Figure 1). The QI team then developed a new workflow linking refill requests with systematic ACT™ assessment and review of asthma-related ED visits/hospitalizations (Figure 2). The intervention was piloted in daily workflow using iterative Plan-Do-Study-Act (PDSA) cycles. Data from electronic medical records were extracted for all patients aged 5-17 with asthma. OAC rates were measured at baseline (March), then May and August 2024. Subgroup analyses examined SDOH variables including English proficiency, socioeconomic status, rurality, Medicaid insurance, and portal use. The project was IRB-exempt.

Results: The patients that met OAC criteria at baseline was 71%, then post-intervention, OAC rates were 69% in May and 70% in August 2024, hence no overall improvement in OAC was observed. However, disparity analysis revealed a reduction in OAC gaps related to English proficiency: the difference between English- and non-English-speaking patients decreased from 11% at baseline (p=0.023) to 6% post-intervention (p=0.18) (Graph 1). No worsening was seen across other SDOH subgroups.

Conclusion(s): Implementation of a refill-based, team-centered asthma control workflow did not improve overall OAC rates during the 6-month period of observation but demonstrated meaningful improvement among non-English-speaking patients and enhanced interprofessional collaboration. The intervention effectively leveraged a previously underutilized patient touchpoint, improved workflow efficiency, and maintained equity across SDOH measures. Our practice will sustain and refine this approach as part of ongoing asthma care quality improvement.

Figure 1: Fishbone Analysis: Root causes for Poor asthma control
Poor asthma control: ACT™ <20 or more than one Emergency room or hospitalization due to asthma in the last 12 months.
ACT™: Asthma control test.
AMQ: Asthma Management Questionnaire (AMQ) is a brief, clinic-developed patient survey that helps record the number of asthma-related ED visits and/or hospitalizations in the past 12 months.
Multidisciplinary team involved in the analysis included: pediatricians, nurses, nurse practitioner with asthma expertise, operational staff, prescription renewal team staff and supervisors, data scientist.

Figure 2: Asthma medication refill workflow for QI project in a pediatric primary care practice.
ACT™ *Asthma control test.
AMQ** The Asthma Management Questionnaire (AMQ) is a brief, clinic-developed patient survey that helps record the number of asthma-related ED visits and/or hospitalizations in the past 12 months. A score of less than 2 (0 or 1) indicates low ED/hospital utilization ( <2 events) and contributes to defining Optimal Asthma Control (OAC) per MNCM criteria.

Graph 1: Optimal asthma control by English proficiency