A Multisite Randomized Trial of the Effects of Physician Education and Organizational Change in Chronic Asthma Care

Sullivan, Sean D.; Lee, Todd A.; Blough, David K.; Finkelstein, Jonathan A.; Lozano, Paula; Inui, Thomas S.; Fuhlbrigge, Anne L.; Carey, Vincent J.; Wagner, Ed; Weiss, Kevin B.

doi:10.1001/archpedi.159.5.428

Cited by 60 publications

(24 citation statements)

References 23 publications

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“…[20][21][22] To improve adherence, researchers have assessed various interventions including clinician education, quality-improvement programs, and incentives. [23][24][25][26] Information systems that provide support to users at the time they make decisions may enable health clinicians to accelerate adoption of guidelines and eventually close the gap between optimal and actual practice. 19,28 There have been other studies that have evaluated CDS designed to improve the management of asthma.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record–Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Electronic Health Record–Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial

et al. 2010

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“…Symptom-free days (SFDs) over the prior 12 months were estimated from the frequency of asthma symptoms in the 2 weeks before the interview 16,17 and parental quality of life (pQOL) was measured using the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ). 18 The parent reported the number of ED visits and hospitalizations in the prior 12-months, whether or not the child had seen a specialist for asthma care at least once in the past 12 months, and provided demographic information.…”

Section: Methodsmentioning

confidence: 99%

Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences

Garbutt

Yan

Strunk

2016

The Journal of Allergy and Clinical Immunology: In Practice

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Background Although specialist asthma care improves children’s asthma outcomes, the impact of primary care management is unknown. Objective To determine if variation in preventive and acute care for asthma in pediatric practices affects patients’ outcomes. Methods For 22 practices, we aggregated 12-month patient data obtained by chart review and parent telephone interviews for 948 children, 3 to 12 years old diagnosed with asthma to obtain practice-level measures of preventive (≥1 asthma maintenance visit/year) and acute (≥1 acute asthma visit/year) asthma care. Relationships between practice-level measures and individual asthma outcomes (symptom-free days, SFD; parental quality of life, pQOL; emergency department visits, ED; and hospitalizations) were explored using generalized estimating equations, adjusting for seasonality, specialist care, Medicaid insurance, single family status, and race. Results For every 10% increase in the proportion of children in the practice receiving preventive care, SFDs/child increased by 7.6 days (p=0.02) and ED visits/child decreased by 16.5% (p=0.002), with no difference in pQOL or hospitalizations. Only the association between more preventive care and fewer ED visits persisted in adjusted analysis (12.2% reduction, p=0.03). For every 10% increase in acute care provision, ED visits/child and hospitalizations/child decreased by 18.1% (p=0.02) and 16.5% (p<0.001), respectively, persisting in adjusted analyses (ED visits 8.6% reduction, p=0.02; hospitalizations 13.9%, p=0.03). Conclusions Children cared for in practices providing more preventive and acute asthma care had improved outcomes, both impairment and risk. Persistence of improved risk outcomes in the adjusted analyses suggests practice-level interventions to increase asthma care may reduce childhood asthma disparities.

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“…SFDs were estimated from the frequency of asthma symptoms in the prior 2 weeks(10, 33) and parental QOL was measured using the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ). (34) This instrument uses a 7-point scale, with a higher score indicating a better QOL.…”

Section: Methodsmentioning

confidence: 99%

A cluster-randomized trial shows telephone peer coaching for parents reduces children's asthma morbidity

Garbutt

Yan

Highstein³

et al. 2015

Journal of Allergy and Clinical Immunology

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Background Childhood asthma morbidity remains significant, especially in low-income children. Most often, asthma management is provided by the child’s primary care provider. Objective To evaluate if enhancing primary care management for persistent asthma with telephonic peer-coaching for parents reduced asthma impairment and risk in children 3–12 years old. Methods Over 12-months peer-trainers provided parents with asthma-management training via telephone (median 18 calls) and encouraged physician partnership. The intervention was evaluated in a cluster-randomized trial of 11 intervention and 11 usual care pediatric practices (462 and 486 families respectively). Patient-outcomes were assessed by telephone interviews at 12- and 24-months conducted by observers blinded to intervention assignment and compared using mixed effects models controlling for baseline values and clustering within practices. In a planned subgroup analysis, we examined heterogeneity of intervention effect by insurance type (Medicaid vs. other). Results After 12-months, intervention participation resulted in 20.9 more symptom-free days/child (95% confidence interval [CI] 9.1 to 32.7) than the control group, and there was no difference in ED visits. After 24-months, ED visits were reduced (difference in mean visits/child 0.28, 95%CI −0.5 to −0.02), indicating a delayed intervention effect. In the Medicaid subgroup, after 12-months, intervention participation resulted in 42% fewer ED visits (difference in mean visits/child −0.50, 95%CI −0.81 to −0.18), and 62% fewer hospitalizations (difference in mean hospitalizations/child −0.16, 95%CI −0.30 to −0.014). Reductions in healthcare use endured through 24-months. Conclusions This pragmatic telephone-based peer-training intervention reduced asthma impairment. Asthma risk was reduced in children with Medicaid insurance. Trial Registration ClinicalTrials.gov: NCT00860834 (http://clinicaltrials.gov/ct2/show/NCT00860834?cond=Asthma&rank=622)

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A Multisite Randomized Trial of the Effects of Physician Education and Organizational Change in Chronic Asthma Care

Cited by 60 publications

References 23 publications

Electronic Health Record–Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial

Electronic Health Record–Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial

Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences

A cluster-randomized trial shows telephone peer coaching for parents reduces children's asthma morbidity

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