Using a computerized kiosk in the emergency department (ED), parents of children with asthma can enter their child's symptoms, current medications, and unmet care needs. The computer kiosk prints out a tailored plan of recommended care based on the input, which parents can share with ED clinicians. So far, however, the kiosk has had a small and variable impact on asthma care quality. Physicians' limited use of kiosk-generated asthma care recommendations may explain the limited impact of the kiosk on asthma care, explains Stephen C. Porter, M.D., M.P.H., of Children's Hospital Boston.
In a study supported in part by the Agency for Healthcare Research and Quality (HS11660), Dr. Porter and colleagues asked parents to use the asthma ED kiosk for their children, who were 1 to 12 years of age and had a respiratory complaint and history of asthma. During the initial 2-month baseline period, no output from the kiosk was shared with physicians, and usual care proceeded. During the 3-month intervention that followed, parents shared the output (which targeted prescription of the inhaled steroid, fluticasone) with ED clinicians. Parents completed a telephone follow-up interview 1 week after their child's discharge.
A total of 131 parents enrolled during baseline, 13 during a 1-week test phase, and 142 during the intervention. The total number of prescribed inhaled corticosteroids did not vary significantly between baseline and intervention. At baseline, physicians prescribed inhaled corticosteroids to 4 of 43 children whose symptoms warranted further investigation, compared with 9 of 50 children during the intervention among the similar groups of children. Providers did prescribe inhaled fluticasone to eligible patients more often during the intervention than baseline (9 of 50 vs. 2 of 43). The average number of parent-clinician partnership problems increased from 1.5 at baseline to 1.9 during the intervention. However, when ED clinicians acted on kiosk data, information problems were fewer (0.6) than when no action was taken (1.1). A mismatch between an activated parent and a less-than-proactive provider may have widened a gap in partnership that the kiosk was meant to narrow.
See "Impact of patient-centered decision support on quality of asthma care in the emergency department," by Dr. Porter, Peter Forbes, M.A., Henry A. Feldman, Ph.D., and Donald A. Goldmann, M.D., in the January 2006 Pediatrics 117(1), pp. e33-e42.