Semester

Summer

Date of Graduation

2025

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Kendra Barker

Committee Member

Aaron Ostrowski

Committee Member

Saif Al Qatarneh

Committee Member

Jamie Rice

Abstract

ABSTRACT

Closing racial and ethnic disparity gaps in pediatric asthma follow up care - A quality improvement initiative

Ayodele Ayeko

Introduction/Background: Inadequate management of asthma significantly contributes to poor asthma control, poor quality of life (QOL), and high hospitalization rates among pediatric patients. The Global Initiative for Asthma (GINA) guidelines offer recommendations designed to enhance asthma control and improve the quality of life for those affected (2015), including recommendations for close follow up care. At WVU Medicine Children’s Hospital (WVUMCH), insufficient asthma control has been associated with lower clinic follow-up rates and an increase in hospitalization. Although educational initiatives aimed at improving asthma management during hospital stays were implemented, the clinic follow-up attendance remained low among children from racial and ethnic minority groups. Staff expressed concerns regarding potential cultural barriers that might hinder access to care.

Purpose: This Doctor of Nursing Practice (DNP) project is a quality improvement initiative, aimed to optimize asthma management and increase the frequency of follow-up visits through a telephone intervention led by a registered nurse for children with asthma who experience racial and ethnic disparities at WVUMCH. The objectives were to 1) Provide a pilot telephone call intervention for patients of African American race/ethnicity and evaluate success for effectiveness and sustainability. 2) Reduce the no-show rate at pulmonary clinic visits by 25% in African American asthma patients’ post hospitalization.

Intervention: The six-month project intervention aimed to follow up with asthma patients from ethnic minority groups, specifically African Americans, through telephone calls after discharge.

Methods: Participant data was extracted from the electronic medical record into the Tableau database by hospital staff. The nursing telephone intervention was executed and measured for time spent to assess feasibility of sustainability. Participants were tracked by the nurse to evaluate follow-up attendance at pulmonary appointments. Deidentified data was used to analyze pulmonology follow-up rates.

Results: Post-intervention (n=8), 37.5% successfully attended and documented follow-up rates in Electronic Medical Record (EMR), while 62.5% followed up elsewhere or delayed entry of asthma information. This represents an improvement compared to the baseline follow-up rate of 28.5% noted in 2023.

Conclusion: While the project cannot ensure the long-term sustainability of the piloted post discharge phone calls, outcomes were notably improved for African American asthma patients. Updating the asthma dashboard after discharge is crucial to avoid missing post-discharge calls before the first follow-up appointment. Additionally, this intervention could be expanded to benefit other minority groups, such as Hispanics. Using the data from this initiative, stakeholders may determine whether the intervention is not only desirable but also sustainable in the long run.

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