33748 Real-world insights into quality improvement in atopic dermatitis care

Abstract

Overview: We conducted a quality improvement (QI) program to identify and develop strategies to address challenges and opportunities for improvement in the case of patients with moderate-to-severe atopic dermatitis (AD). Methods: To identify gaps and inform team-based improvements in AD care, surveys on clinical practice trends and challenges were administered to 8 clinical teams (5 dermatology and 3 allergy-immunology practices). Teams then participated in audit-feedback sessions, led by AD expert faculty, to review their data and set action plans. Results: Surveys were collected from 86 health care providers (HCPs) (29% physicians, 19% physician assistants, 15% nurse practitioners, 37% nurses). On a 5-point Likert scale, most HCPs (62%) reported always assessing pruritus, although fewer HCPs always assessed sleep quality (26%) and mental health (19%). Most HCPs reported using oral steroids to treat flares (59%) and to bridge to maintenance therapy (43%). Among pediatric patients, top barriers to biologic therapy were patient/caregiver safety concerns (75%); needle phobia (55%); and cost (27%). Key challenges discussed in the audit-feedback sessions included assessment of disease severity and control; use of biologic therapies and systemic steroids; and shared decision-making. Teams designed action plans to integrate into workflows, including using tools to improve disease assessment; developing standardized documentation practices; creating patient education tools; utilizing steroid-sparing strategies; and improving communication with primary care providers. Conclusions: HCPs encounter several challenges in managing patients with AD. Expert-led audit-feedback sessions can help teams design strategies to address these challenges. Findings from this program can inform future education and QI activities.