Electronic health record–based decision support to improve asthma care: a cluster-randomized trial

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Asthma affects approximately 6 million US children [1]. This study was conducted to find out if electronic health record (EHR) with clinical decision support (CDS) can improve adherence to National Asthma Education Prevention Program (NAEPP) guidelines.


A cluster-randomized trial was conducted over a period of twelve months at 4 urban and 8 suburban primary care sites. The practices were divided in to two groups. The interventions group is where the practice had the asthma management tool with an active CDS alert and the control group that had tool available passively. With the help of ICD-9 for asthma, children 18 years and under with persistent asthma were identified.


The outcomes were measured using three criteria. 1. Prescription of at least one controller medication: Interventional group showed a 7% increase compared to 1% increase at control group. 2. Asthma care plan (ACP) up to date: 14% rise was seen at interventional group verses 11% at control group sites. 3. Spirometry performed: In Interventional group from use of spirometry went up from 15% to 24%, whereas control group showed slum from 8% to 1%.


Three other studies that assessed the impact of CDS on asthma management showed no significant improvement on patient outcome and process of care. In the present study the urban practices showed an improvement in the prescription of controller medications and spirometry use. The suburban practices showed enhancement with documentation of ACP and use of spirometry. As evident from the results the active CDS alert helped improve compliance with the NAEPP guidelines.


EHR with active CDS at point of care improves compliance with guidelines.


It’s interesting to learn that having a passive CDS with EHR, does not really seem to serve the purpose of having CDS, for compliance with clinical guidelines and evidence based medicine. To see the positive effects of EHR with CDS, it needs to be made available actively at point of care.

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  1. Bell, L. M., Grundmeier, R., Localio, R., Zorc, J., Fiks, A. G., Zhang, X., ... & Guevara, J. P. (2010). Electronic health record–based decision support to improve asthma care: a cluster-randomized trial. Pediatrics, 125(4), e770-e777. http://pediatrics.aappublications.org.ezproxyhost.library.tmc.edu/content/125/4/e770.full.pdf+html