Improved Asthma Outcomes Using a Coordinated Care Approach in a Large Medical Group

Abstract

The objective of this study was to review the development of a multidisciplinary asthma disease management program in a large medical group practice in an urban area, and evaluate the impact of the program on processes of care and health care utilization for adults and children with asthma. The disease management intervention included the development of a patient registry, a systematic approach to assessment of asthma control using the Asthma Therapy Assessment Questionnaire (ATAQ), case management, and physician education. An administrative database was used to examine hospital admissions and emergency department (ED) visits. A medical record audit was conducted to examine recorded compliance with asthma guidelines and documentation practices. The baseline study population included 3486 adults and children with asthma. The ATAQ suggested that, at baseline, control problems were frequent, with 34% of adult respondents missing work because of asthma. ATAQ also revealed several areas for care improvement. For example, only 20% of adult respondents reported having a written treatment plan. The chart review and administrative claims analyses showed that the program had beneficial results in several areas. Medical record documentation improved for asthma diagnosis (83.3% vs. 98.6%; p < 0.001) and patient education (15.7% vs. 26.1%; p < 0.001). No improvements were seen in documentation of peak flow ownership/use, smoking cessation advice, or influenza vaccination. ED visits related to asthma decreased from 148 per 1000 to 88 per 1000 (p < 0.001), and hospitalizations related to asthma decreased from 81 per 1000 to 37 per 1000 (p < 0.001). The outcomes suggest that this program was associated with a marked reduction in rates of hospitalization and ED usage for asthma, as well as significant improvement in several essential processes of care.

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

“…79,80,89 Only 1 of 4 studies, a pre-post study, reported a significant reduction in ED visits: a 41% reduction in ED visits and 54% reduction in hospitalizations (P , .001 for both). 90 The other pre-post study reported a 4% reduction in hospitalizations (no P value reported). 80 The 2 RCTs reported 1% (P .…”

“…89,90 A pre-post study (instituting a registry to track asthma patients and an asthma case manager) reported a 10% increase in patient education (P , .001) and a 14% increase in asthma action plan dispensations (P , .001). 90 In the RCT (a restructured clinical protocol for how asthma patients are cared for during ambulatory care encounters; "3+ visit plan"), there was a 10% increase in the provision of asthma education (P = .01). 89 SOE: low.…”

“…We identified 4 studies, 79,80,89,90 which included restructured asthma care visits, 89 supplemental trained personnel, and provider education. 79,80,90 Three studies focused on pediatric providers.…”

“…79,80,90 Three studies focused on pediatric providers. 79,80,89 Only 1 of 4 studies, a pre-post study, reported a significant reduction in ED visits: a 41% reduction in ED visits and 54% reduction in hospitalizations (P , .001 for both).…”

Evaluation of a Practice-Based Intervention to Improve the Management of Pediatric Asthma

“…5,6 Studies of approaches to improving practitioners' adherence to the guidelines have found that a variety of multidimensional approaches to clinician education are somewhat effective in changing physician behavior and improving health outcomes. 4,[7][8][9][10][11] However, a randomized, controlled trial of a continuous quality improvement intervention did not significantly affect processes or outcomes of care for children with asthma. 12 What generally emerges from the literature is that to be effective, interventions must be tailored to the environment and culture in which they are implemented.…”