Impact of Patient-Centered Decision Support on Quality of Asthma Care in the Emergency Department
Stephen Porter, Children's Hospital Boston Peter Forbes, Children's Hospital Boston Henry Feldman, Children's Hospital Boston Donald Goldmann, Children's Hospital Boston

Background: The asthma kiosk, a patient-driven decision support tool, provides emergency department (ED) clinicians with tailored care recommendations. Objective: We evaluated the impact of the asthma kiosk on measures of quality for ED care. Methods: A clinical trial with baseline and intervention periods in a pediatric ED. Parents of children with asthma used the kiosk to report symptoms and medications. Usual care occurred during a two-month baseline. For the intervention, kiosk output was shared with clinicians. Primary outcomes were: prescription of controller medication when indicated and mean problem scores for two dimensions of care: information-sharing and partnership. Results: Over 5 months, 1090 parent-child dyads were screened; 430 were eligible. 286/430 (66.5%) parents enrolled (131 during baseline, 13 during a test phase, and 142 during intervention). Total number of prescribed controllers did not vary between intervention and baseline (9/50 versus 4/43, p=0.37.) Physicians prescribed fluticasone more often during intervention than baseline (9/50 versus 2/43, p=0.06.) Reported information problems and partnership problems were unchanged overall between periods. When clinicians used the output, reported information problems were fewer (0.6 +/- 0.8) than when no action was taken (1.1 +/- 1.1), p=0.06. Conclusions: The asthma kiosk demonstrated small and variable impact on quality.