Improving the Use of Spirometry in the Diagnosis and Management of Asthma with an EMR Alert

Rationale: The 2007 National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma and AAAAI’s Choosing Wisely campaign recommend that asthma should not be diagnosed or managed without spirometry. In an effort to facilitate the implementation of these guidelines, a quality improvement project to design and implement an electronic medical record (EMR) reminder system was undertaken.

Methods: A retrospective pre-intervention cross-sectional analysis of spirometry use in asthma was completed using the EMR system at a tertiary care institution. The primary outcome was to determine the percentage of asthma patients with spirometry testing. The secondary outcome was to evaluate the rate of acute asthma exacerbations in patients with and without spirometry testing. After review of this data and current guidelines, an EMR reminder system was generated and implemented with a plan for post-intervention data review.

Results: Pre-intervention analysis revealed poor guideline adherence with only 26.2% of all asthma patients having spirometry performed. In patients with current asthma, defined as a physician’s diagnosis of asthma and an albuterol prescription in the past year, 22.8% of those patients with recent spirometry had an acute exacerbation, compared to 46.6% in patients without recent spirometry and 25.1% in patients with no record of spirometry.

Conclusions: We recommend the initiation of an EMR reminder system to improve guideline compliance and expect that post-intervention data analysis will reveal an appropriate increase in use of spirometry. This will ideally result in a reduction of acute asthma exacerbations and could reduce costs associated with acute asthma care.