Primary Care Clinical Pathway for Children with Known Asthma Diagnosis or Suspected Asthma

Goals and Metrics
Patient Education
Patient with Known Asthma Diagnosis or Suspected Asthma
Concern for respiratory distress refer to Primary Care Acute Asthma Pathway
RN/MA Assessment, Vital Signs, Respiratory Rate, Spirometry in children ≥ 6 years of age
Use Asthma Order SmartSet
New Diagnosis
API, preschool age
Early frequent wheezer (≥ 3x) and 1 major
or 2 minor
Major Criteria
  • Parental MD asthma
  • MD diagnosed eczema + skin/blood test to one allergen
Minor Criteria
  • Wheezing apart from colds
  • Eosinophilia
  • Allergic sensitization to milk, egg or peanuts
  • Allergic rhinitis
Treat According to Severity
  • Create Asthma Care Plan in EPIC
  • Discharge Instructions and Education
    • Provider Teaching:
      • Use EPIC Asthma Medicaid orderset as appropriate
      • Discuss medication
    • RN/Asthma Navigator Teaching:
      • Use Epic Care Assistant Teaching Tool
      • Teach device technique
      • Discuss adherence
      • Reinforce/dispense medication
Follow-up
  • Scheduled follow-up in 2-4 weeks to confirm diagnosis
  • Follow known-diagnosis pathway if confirmed diagnosis
  • Use EPIC Asthma Medicaid Order Set as appropriate
Known Diagnosis
  • Goal: Achieve Asthma Control
  • By reducing impairment and risk
Asthma Treatment: Step up, step down
  • Update Asthma Care Plan in EPIC
  • Discharge Instructions and Education
    • Provider Teaching:
      • Use EPIC Asthma Medicaid orderset as appropriate
      • Discuss medication
    • RN/Asthma Navigator Teaching:
      • Use Epic Care Assistant Teaching Tool
      • Teach device technique
      • Discuss adherence
      • Reinforce/dispense medication
Follow-up
  • Follow-up recommendations:
  • While gaining control: every 2-6 weeks
  • Monitoring Control: every 1-6 months
  • Anticipating Step-down of therapy: every 3 months
  • Referrals
    • Pulmonary & Allergy for Problematic Asthmatics (PAPA) Clinic, Allergy/Immunology, Pulmonary
  • Use EPIC Asthma Medicaid order set as appropriate
Posted: February 2020
Revised: February 2021
Authors: T. Bryant-Stephens, MD; M. Jackson-Ware, RN; L. Biggs, MD; K. Dang, MD; K. Filograna, MD; A. Moore, PharmD; V. Schied, MD; S. Tomaine, DO