Evaluation of a Quality Improvement Collaborative in Asthma Care

Does It Improve Processes and Outcomes of Care?

Published in: Annals of Family Medicine, v. 3, no. 3, May/June 2005, p. 200-208.

Posted on RAND.org on December 31, 2004

by Matthias Schonlau, Rita Mangione-Smith, Kitty S. Chan, Joan Keesey, Mayde Rosen, Thomas A. Louis, Shin-Yi Wu, Emmett B. Keeler

PURPOSE: The authors examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults. METHOD: They undertook a preintervention-postintervention evaluation of 185 patients in 6 intervention clinics and 3 matched control sites that participated in the Institute for Healthcare Improvement Breakthrough Series (BTS) Collaborative for asthma care. The intervention consisted of 3, 2-day educational sessions for teams dispatched by participating sites, which were followed by 3 action periods during the course of a year. RESULTS: Overall process of asthma care improved significantly in the intervention compared with the control group (change of 10% vs 1%, P =.003). Patients in the intervention group were more likely to attend educational sessions (20% vs 5%, P =.03). Having a written action plan, setting goals, monitoring peak flow rates, and using long-term asthma medications increased between 2% and 19% (not significant), but asthma-related knowledge was unchanged for the 2 groups. Patients in the BTS Collaborative were significantly more likely to be satisfied with clinician and lay educator communication (62% vs 39%, P =.02). Health-related quality of life, asthma-specific quality of life, number of bed days caused by asthma-related illness, and acute care service use were not significantly different between the 2 groups. CONCLUSIONS: The intervention was associated with improved process-of-care measures that have been linked with better outcomes. Patients benefited through increased satisfaction with communication. Follow-up of patients who participated in the intervention may have been too brief to be able to detect significant improvement in health-related outcomes.

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