P0135 - Improving Rates of Timely Completion of School Asthma Medication Administration Forms Using Data From the Electronic Health Record

Background: Asthma exacerbations are a major cause of school absence; emergency room visits, and hospitalizations among urban youth. These exacerbations and their consequences are particularly common in low-income neighborhoods such as the South Bronx, where asthma-related ED visits are three times as frequent as in New York State. Decreasing exacerbations in this vulnerable population requires coordination between primary care providers and caretakers in a child’s two primary environments: home and school. The New York City Department of Education provides an Asthma Medication Administration Form (AMAF), which allows clinicians to authorize school nurses to administer asthma medication in school. However, most students do not have AMAFs completed, and some caregivers are not even aware such a form exists. Without an AMAF, school nurses cannot administer asthma medication, forcing those children who suffer from an asthma attack to leave school, and go to the emergency room, often times exacerbating school absenteeism and poor performance in school.

Purpose: To describe the effectiveness of implementing a proactive approach to timely AMAF completion and distribution to parents in an urban primary care setting.

Methods: Patient-specific information required to complete AMAFs was extracted from the electronic health records (EHR) for all moderate and severe persistent school-aged asthmatics (N=227) in care between July 1st, 2018 and June 30th, 2019. The data was synthesized for each patient and organized into a comprehensive, provider-specific dashboard. Providers used the dashboard to input and capture all questions required of the AMAF. Non-clinical staff then generated AMAFs using the providers’ answers. Completed forms were returned to the providers for review and final signature, and were mailed directly to families before the start of the school year. After the intervention, provider feedback was solicited in structured, one-on-one interviews.

Results: Compared to the 2018-2019 school year, the percent of moderate to severe persistent asthmatics with completed AMAFs within the first month of the 2019-2020 school year (prior to September 30th) increased from 21% to 53%. This approach also yielded an increase in overall form completion by providers, jumping from 49% to 68%. Of participating providers who were interviewed for their feedback (N=6), 100% indicated that the timely completion of AMAFs is important and affirmed that this effort was helpful in doing that.

Discussion: The dashboard used in this intervention allowed providers to proactively and efficiently complete asthma forms, simultaneously improving quality of care while reducing provider time spent on clerical tasks, including searching through the EHR. Future interventions will incorporate provider feedback and refine the workflow to further achieve the end goal of improving communication between the home, clinic and school environments. Future efforts will be aimed at linking this intervention to outcome measures, such as school absenteeism and steroid use.