SAN FRANCISCO — A small intervention had a sizable impact on documentation of asthma severity and appropriate treatment of children at an inner-city health center, according to results of a randomized controlled trial reported in a poster at the annual meeting of the Pediatric Academic Societies.
Every other week for 6 weeks, Dr. Sandra F. Braganza and her colleagues affixed 2-by-3-inch stickers to the charts of children scheduled for health center visits who had previously been diagnosed with asthma.
The stickers listed the National Asthma Education and Prevention Program (NAEPP) criteria for asthma severity classification. Highlighted in red were the criteria for prescribing inhaled steroids.
“It prompts the physicians to classify asthma severity, and by physicians classifying asthma severity we hope they are properly treating the child's asthma,” said Dr. Braganza of Albert Einstein College of Medicine and Montefiore Medical Center, New York.
The children's appointments were not necessarily for asthma, she noted in an interview at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.
After each visit—during weeks when the stickers were used and the alternate weeks when they were not—a research assistant interviewed the children's parents about the severity of each child's asthma and each child's use of medications. The assistant was blinded to what the physicians had written and prescribed.
Analysis of charts and parent interviews showed significant differences in asthma care between the intervention group and the control group of children who visited the clinic when stickers were not used.
The clinicians documented asthma severity for 135 (98%) of 138 children who had stickers on their charts but only 128 (73%) of 175 children in the control group who did not.
Moreover, review of 263 charts with notations for asthma severity revealed that physicians were significantly more likely to classify severity correctly when they had information on the classification criteria in front of them. They did so on 46% of charts with stickers but only 28% of charts for children in the control group.
The charts with the stickers affixed also were more likely to contain records of appropriate therapy, as defined by use of inhaled corticosteroids in children whose symptoms were consistent with persistent asthma. Appropriate therapy was recorded on 64% of charts with stickers but only 50% of charts for the control group.
Dr. Braganza and her colleagues calculated that the little sticker more than doubled the odds of a child having a correct asthma severity classification (adjusted odds ratio, 2.58) and significantly increased the odds of a child receiving appropriate therapy according to NAEPP criteria (adjusted odds ratio, 1.77).