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

Okelo, Sande O.; Butz, Arlene; Sharma, Ritu; Diette, Gregory B.; Pitts, Samantha I.; King, Tracy M.; Linn, Shauna T; Reuben, Manisha; Chelladurai, Yohalakshmi; Robinson, Karen A.

doi:10.1542/peds.2013-0779

Cited by 102 publications

(82 citation statements)

References 82 publications

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“…In particular, recent improvements in asthma outcomes are larger among non-Hispanic white Americans than among African Americans (39). Systematic reviews have shown that many healthcare providers do not adhere to clinical practice guidelines, and efforts to improve providers' compliance have had limited success (40). In addition, many interventions are now available for broadscale dissemination, but these interventions lack an efficient mechanism for dissemination.…”

Section: Implementation Researchmentioning

confidence: 99%

Future Research Directions in Asthma. An NHLBI Working Group Report

Levy

Noël

Freemer

et al. 2015

Am J Respir Crit Care Med

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Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification, and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare use and costs persist. To address this important clinical condition, the NHLBI convened a group of extramural investigators for an Asthma Research Strategic Planning workshop on September 18-19, 2014, to accelerate discoveries and their translation to patients. The workshop focused on (1) in utero and early-life origins of asthma, (2) the use of phenotypes and endotypes to classify disease, (3) defining disease modification, (4) disease management, and (5) implementation research. This report summarizes the workshop and produces recommendations to guide future research in asthma.

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Section: Implementation Researchmentioning

confidence: 99%

Future Research Directions in Asthma. An NHLBI Working Group Report

Levy

Noël

Freemer

et al. 2015

Am J Respir Crit Care Med

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“…Concerning the composition of papers according to the studied conditions, of the 53 study papers, 18 evaluated the quality of care provided for cardiovascular disorders (33-50) and 12 evaluated cancer conditions (51-62). Eight assessed metabolic disorders and diabetes (63)(64)(65)(66)(67)(68)(69)(70), six assessed acute infections (71)(72)(73)(74)(75)(76), three assessed orthopedic and trauma conditions (77)(78)(79), two assessed pediatric conditions (80,81), two assessed obstetric and gynecological conditions (82,83), one assessed asthma and allergic diseases (84), and one assessed geriatric conditions (85). The majority of the studies (51 in 53 articles) were carried out in high-income countries.…”

Section: Resultsmentioning

confidence: 99%

Assessment of Healthcare Providers’ Performance Considering Three Healthcare Quality Indicators: A Review Article

2016

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Context: In many healthcare systems, the quality of the healthcare delivered is monitored using a number of "indicators." In the present review, we investigate studies that address issues with the care delivered by healthcare providers. To do this, we employ indicators of the quality of those healthcare services. Evidence Acquisition:The studies for the review were identified by searching a number of electronic databases, including Cochrane Library, PubMed, Scopus, Ovid (Medline), the Social Sciences Citation Index, SID (Scientific Information Database, or Persian database), and Iran Medex (Persian database). Of 8,850 studies published between January 1971 and May 2015, 53 met the study criteria and were reviewed. In this study, the following key words were searched, both alone and in combination: health, healthcare, health care, provider*, effectiveness, quality, clinical outcome, patient satisfaction, and quality of life. We also considered healthcare quality indicators such as "clinical outcome," "patient satisfaction," and "quality of life" for our assessment of the quality of healthcare providers.Results: Of the 53 papers selected, 18 assessed the quality of care provided for cardiovascular disorders, 12 studied cancer conditions, eight dealt with metabolic disorders and diabetes, six focused on acute infection, three assessed orthopedics and trauma conditions, two studied pediatric conditions, two assessed obstetrics and gynecology conditions, one dealt with asthma and allergic disease conditions, and one assessed geriatric conditions. In our assessment of improvements in healthcare providers' performance based on healthcare quality indicators, improvements in clinical outcomes ranged from 26.6% for cancer conditions to 98.8% for pediatric and gynecological conditions. An acceptable level of patient satisfaction was achieved in the range of 30.2% for cancer conditions to 96.0% for pediatric conditions, while improvements to quality of life ranged from 12.5% for cancer conditions to 88.7% for acute infection.Conclusions: Taking account of three indicators for assessing the quality of healthcare providers (clinical outcome, patient satisfaction, and quality of life), the highest improvement levels among providers were observed for pediatric and gynecological conditions, and the lowest improvement levels were found for cancer conditions.

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“…Adding nurse managers, plus "intense interaction" with families and home visits, both Woods et al 72 and Lob et al 69 demonstrated a pre-to-post decrease in rates of asthma ED visits (68% and 70%, respectively), whereas Bunik et al 64 and Vernacchio et al 68 used similar methods but found no improved outcomes, with improvement only in documentation of care processes. Okelo and colleagues 12 highlighted the lack of studies that assessed patient outcomes even when introducing intensive external practice support. In contrast, we found that the Asthma APGAR tools improved patient outcomes and requires little additional practice support.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13] Use of a metric for assessing asthma control has been suggested for improving asthma care, and several asthma control scores have been developed and validated against allergists' assessments.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] Implementation of asthma guidelines has been challenging, and the burden of asthma remains high with little improvement from 1990 to 2010. [6][7][8][9][10][11][12][13] Use of a metric for assessing asthma control has been suggested for improving asthma care, and several asthma control scores have been developed and validated against allergists' assessments. [14][15][16][17][18][19][20][21][22][23][24][25] But use of these tools remains limited and has not significantly improved asthma outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

et al. 2018

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PURPOSE The purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices. METHODSWe used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines. RESULTSWe enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with "in control" asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year (P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).CONCLUSIONS Introduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices' adherence to asthma management guidelines. Ann Fam Med 2018;16:100-110. https://doi.org/10.1370/afm.2179. INTRODUCTIONA sthma is a common chronic condition, [1][2][3] and primary care is the site of most asthma diagnoses and management.2-5 Implementation of asthma guidelines has been challenging, and the burden of asthma remains high with little improvement from 1990 to 2010. [6][7][8][9][10][11][12][13] Use of a metric for assessing asthma control has been suggested for improving asthma care, and several asthma control scores have been developed and validated against allergists' assessments.14-25 But use of these tools remains limited and has not significantly improved asthma outcomes. 23,[26][27][28][29][30][31][32][33][34][35][36] The Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) (Figure 1) tools were developed not only to provide a score for asthma control, but also to guide further evaluation of inadequate control with a link to a care algorithm (Supplemental Figure 1, available at http://www.annfammed.org/content/16/2/100/suppl/ DC1/). In a small pilot study, use of the Asthma APGAR tools was associated with enhanced asthma guidelines adherence, and focus groups of patients an...

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

Cited by 102 publications

References 82 publications

Future Research Directions in Asthma. An NHLBI Working Group Report

Future Research Directions in Asthma. An NHLBI Working Group Report

Assessment of Healthcare Providers’ Performance Considering Three Healthcare Quality Indicators: A Review Article

Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

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