Use of the Pan-Canadian Respiratory Standards Initiative for Electronic Health Records (PRESTINE) and a severe asthma algorithm in an asthma education center Electronic Medical Record (EMR)

RATIONALE We describe the use of Pan-Canadian Respiratory Standards Initiative for Electronic Medical Health Records (PRESTINE) data elements and a severe asthma (SA) algorithm for performance evaluation in an asthma education center.METHODS PRESTINE data elements and a SA algorithm were programmed into an asthma charting tool integrated within a tertiary care electronic health record. In this retrospective observational study, Primary Care Asthma Performance Indicators (PC-APIs©) were compared before and after the SA algorithm implementation, to assess changes in asthma care by certified respiratory educators (CREs) across patients with suspected, non-severe and SA. The unit of analysis was the visit, but tests used robust standard errors to account for within-patient dependence.RESULTS Of 828 patient assessments from 470 patients, 672 assessments with complete data from 388 patients were included. Asthma was confirmed in 93 SA and 315 non-SA patients. Inhaler technique, medication adherence, triggers and environmental controls were documented in 80–90% of visits. Confirmed asthma diagnoses increased in SA (21% to 43%, p = 0.008, FDR [false discovery rate] = 0.052) and non-SA patients (26% to 45%, p = 0.002, FDR = 0.021). Spirometry monitoring rose in SA patients (38% to 67%, p = 0.016, FDR = 0.080). Well-controlled asthma increased in SA from 21% to 46% (p = 0.001, FDR = 0.013). Written action plans increased to 94% in both non-SA and SA. All 3 groups reported more symptom free days in the post study period.CONCLUSION The PRESTINE data elements and the SA algorithm support CRE’s asthma care delivery, identify uncontrolled SA and facilitate performance evaluation, outcomes monitoring, benchmarking, and national surveillance.