Project BREATHE: A Quality Improvement Initiative

Abstract

Introduction: Asthma is the most common chronic illness in pediatrics, placing a significant burden on patients and the healthcare system. The lack of standardization in screening, diagnosis, and treatment remains a key challenge in pediatric asthma management. This project used the Project BREATHE toolkit, supplied through the New York State Department of Health, to implement a care process for children with asthma receiving care at our institution. Our primary objective was to enhance asthma care through a quality improvement framework to optimize outcomes and reduce healthcare usage.

Methods: Following identifying key drivers contributing to suboptimal asthma care in our region, our transdisciplinary team developed a standardized asthma care process. From July 2020 to June 2021, the process was systematically applied to all patients admitted with a diagnosis of asthma. Control charts were reviewed monthly to assess adherence and uptake of care process components, facilitating continuous quality improvement and data-driven modifications.

Results: Following implementation, inhaled corticosteroid prescriptions increased from 50% to 81%, whereas subspecialist consults rose from 8.3% to 77%. The proportion of patients receiving asthma severity assessments ranged from 71% to 90%, and the rates of asthma education fluctuated from 50% to 89%. Additionally, the rate of emergency department visits declined from 5.2% to 4.7% and hospitalizations from 12.7% to 10.1% following implementation.

Conclusions: Implementing a transdisciplinary asthma care process resulted in sustained improvements in asthma management and reduced asthma-related emergency department visits and hospitalizations. These findings highlight the effectiveness of a structured, team-based approach in optimizing pediatric asthma care.

Fig. 1.

Fishbone diagram of factors influencing asthma care in WNY.p/cg, patient/caregiver; PCP, Primary Care Physician; WNY, Western New York.

Fig. 2.

Project BREATHE NY Key Driver Diagram for WNY. WNY, Western New York.

Fig. 3.

Monthly rolling rate of hospitalizations due to asthma at OCH from July 2020 to June 2021. Baseline data corresponds to 6 months before the start of Project BREATHE. The U-chart shows a decrease in hospitalization rates for asthma over time, pre- and postimplementation of Project BREATHE. LCL, lower control limit; UCL, upper control limit.

Fig. 4.

Monthly rolling rate of ED visits for asthma at OCH from July 2020 to June 2021. Baseline data corresponds to 6 months before the start of Project BREATHE. The U-chart shows a decrease in rates of ED visits for asthma over time, pre- and postimplementation of Project BREATHE. LCL, lower control limit; UCL, upper control limit.

Fig. 5.

p-Chart of Project BREATHE packet completions per month. The initial 6 months were established as the baseline. The data show a centerline shift after 6 months of baseline, with an increase in the average packet completion rate, and the new values fall outside the previous control limits, indicating special cause variation. LCL, lower control limit; UCL, upper control limit.