Classification of Asthma in a Resident Based Primary Care Clinic
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Sima J. Patel, Saritha Kartan, Yulanka Castro, Mirela Feurdean
Rationale: Asthma is a chronic inflammatory airway disease characterized by reversible airflow obstruction and bronchospasm. Its prevalence has increased significantly since the 1970s; as of 2011, 235 million people worldwide were affected, resulting in 250,000 deaths annually. The most common symptoms include: cough, wheezing, chest tightness, and shortness of breath. Asthma is clinically classified into four severity categories according to symptom frequency, FEV1, or peak expiratory flow rate. A reliable system for diagnosis and severity classification is essential to guide treatment and decrease death. 

Methods: Our study examined adherence to National Guidelines for asthma diagnosis and classification of disease severity in the University Hospital resident based primary care clinic. This was a retrospective chart review of consecutive patients seen for asthma between January-June 2013. 

Results: 197 unique visits were reviewed using Epic EMR. 78% of patients were female and the mean age was 50 years (SD=13).  Categorization of asthma based on symptom severity was documented in 22% of notes. PFTs were documented in 30% of the patients. COPD was an accompanying diagnosis in 15% of the encounters; of these 76% had PFTs reported. Standardized clinical evaluation of weekly albuterol use, recent hospitalizations and presence of nighttime symptoms was documented in 26%, 17% and 11% of the notes, respectively. 

Conclusions: It is evident that characterization of asthma is suboptimal in the resident primary care clinic. An implementation to improve classification of, and ultimately treat patients is developing an Epic SmartSet using applicable questions. Future studies include analyzing charts post-SmartSet implementation to assess for improvement.