Abstract Rationale Patient-reported measures are guideline-recommended for assessing asthma control. The Asthma Control Test (ACT) is a validated, self-administered questionnaire assessing asthma control over the prior four weeks but remains underused in ambulatory care. This quality improvement initiative aimed to increase pre-visit ACT completion by embedding an automated questionnaire in the patient portal check-in with structured capture and real-time use by providers in the electronic medical record (EMR). Methods We implemented an EMR-integrated, portal-based ACT for pre-visit online check-in across multiple outpatient pulmonary clinics within a large urban health system. Responses were written to a structured flowsheet and were retrievable in notes via a smart-phrase. All providers were notified of this process and advised to incorporate the ACT into their workflow and documentation. We conducted a pre- and post-intervention chart review of adult asthma visits to evaluate the utility of the ACT in the clinical encounter. The primary outcome was ACT completion with clinician documentation. We also summarized patient portal (MyChart) activation and sociodemographic characteristics (age, sex, race/ethnicity, insurance). Results A total of 114 adult asthma visits were analyzed. ACT documentation increased from 12% pre-intervention to 29% post-intervention, an absolute increase of 17% and a 2.4-fold relative improvement. Patient portal (MyChart) activation was high (89%). The cohort was older (mean age 64 ± 15 years; median 65, IQR 57.5-72.5) with 9% aged 40, 39% aged 40-64, and 52% aged ≥65. Women comprised 70% and men 30%. Insurance coverage was 46% Medicare, 32% Medicaid, and 22% Commercial/Private. By race/ethnicity, the cohort was 28% White, 25% Black/African American, 6% Asian, 1% Native Hawaiian/Other Pacific Islander, 35% Other/Hispanic or Latino, and 5% Unknown/Declined. Conclusions Embedding an automated, portal-based ACT into pre-visit check-in across multiple outpatient pulmonary clinics was associated with a meaningful early improvement in ACT documentation within a socioeconomically disadvantaged population with variable clinic attendance. Portal enablement was a principal driver of reach. Although capture remained below guideline targets, this early-phase evaluation establishes a scalable, low-burden process via structured flowsheet capture, smart-phrase retrieval, and operational patient reminders that can be deployed system-wide and adapted as guideline-oriented quality metrics evolve. Future interventions include targeted provider education on the importance of patient-reported questionnaires for symptom assessment and driving guideline-concordant care. Next steps include multilingual prompts, point-of-care portal activation, text-message/kiosk fallbacks for non-portal users, and prospective linkage of ACT completion to treatment adjustments and outcomes to drive sustained, equitable improvements in asthma care quality. This abstract is funded by: None
Gallub et al. (Fri,) studied this question.