A Dual-Intervention Quality Initiative to Improve Asthma Action Plans and Standardize Documentation

Introduction: Asthma affects over 25 million individuals in the U.S., yet outpatient control remains suboptimal. Key components of high-quality care include personalized Asthma Action Plans (AAPs) and accurate severity documentation to guide guideline-based management. At our internal medicine residency clinic, baseline review revealed low AAP use and inconsistent classification. We launched a dual-intervention quality improvement (QI) initiative to enhance patient education and documentation through resident engagement, printed AAP templates, and a standardized EMR smart phrase.


Methods: A retrospective review of 50 adult asthma visits from February 2024 to February 2025 assessed documentation of Asthma Action Plans (AAPs), asthma severity classification, and use of the teach-back method. Two targeted interventions were implemented. The first focused on AAP implementation through weekly educational emails, printed AAP templates placed in clinic workspaces, and reinforcement of zone-based education using the teach-back method. The second intervention standardized documentation with a comprehensive EMR smart phrase (.ASTHMAACTIONPLAN), prompting providers to record asthma severity, control level, common triggers, medication review, rescue inhaler frequency, zone assessments, spacer technique, educational materials, follow-up plans, and patient understanding. Weekly reminders supported consistent use across clinic encounters.


Results: Following the intervention (n=50 visits), we observed significant improvements:
- AAP Provided: Increased from 2% to 78%
- Education Documentation: Improved from 2% to 70%
- Severity Classification: Increased from 54% to 93%
- Smart Phrase Use: Increased from 32% to 87%


Conclusions: This dual-intervention QI project demonstrated that simple, low-cost strategies—resident education and EMR optimization—can significantly improve asthma care. The smart phrase streamlined documentation while promoting guideline-concordant care, and printed AAPs enhanced patient understanding. Adoption was rapid and sustained among residents. Future directions include embedding editable AAP templates directly into the EMR and using Best Practice Alerts to further improve standardization and sustainability.