The Colorado Asthma Toolkit Program: A Practice Coaching Intervention from the High Plains Research Network

Bender, Bruce G.; Dickinson, Perry; Rankin, Allison; Wamboldt, Frederick S.; Zittleman, Linda; Westfall, John M.

doi:10.3122/jabfm.2011.03.100171

Cited by 35 publications

(50 citation statements)

References 28 publications

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“…75 The pre-post studies reported increases in the provision of action plans (27%-46%). [76][77][78]88 Both RCTs reported nonsignificant increases in patient education/asthma action plans (7% in 1 study; relative risk = 1.82 in the other study). 73,75 SOE: low.…”

Section: Multicomponentmentioning

confidence: 99%

“…Two of the 3 pre-post studies reported 25% to 49% increases in prescribing rates. 76,77 Three of the 4 RCTs reported no statistically significant effects.…”

Section: Multicomponentmentioning

confidence: 99%

“…Of the 6 studies we reviewed, 73,[75][76][77][78]88 most included an educational component but also included (1) training in communication techniques with provision of a spirometer and training in use of the spirometer 76 ; (2) laminated posters of guidelines and medications with feedback on asthma action plan use and monthly calls from an intervention team to troubleshoot communication problems 88 ; (3) asthma kits (peak flow meters, spacers, educational materials) and systems-level changes (flow sheets and standing medication orders) 73 ; (4) systematic use of a patient questionnaire and an asthma management algorithm 77 ; (5) an asthma coordinator and feedback on performance as part of continuous quality improvement efforts; or (6) an educational toolbox with seminars, teleconferences, mini fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. 75 The pre-post studies reported increases in the provision of action plans (27%-46%).…”

Section: Multicomponentmentioning

confidence: 99%

“…[72][73][74][75][76][77][78] All interventions included information, education, and at least 2 of the following: organizational change, decision support, and feedback and audit. Two of the 3 pre-post studies reported 25% to 49% increases in prescribing rates.…”

Section: Multicomponentmentioning

confidence: 99%

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

Butz²,

et al. 2013

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BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers' adherence to asthma guidelines on health care process and clinical outcomes. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-forperformance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. METHODS:CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. Pediatrics 2013;132:517-534

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Section: Multicomponentmentioning

confidence: 99%

“…Two of the 3 pre-post studies reported 25% to 49% increases in prescribing rates. 76,77 Three of the 4 RCTs reported no statistically significant effects.…”

Section: Multicomponentmentioning

confidence: 99%

Section: Multicomponentmentioning

confidence: 99%

Section: Multicomponentmentioning

confidence: 99%

See 2 more Smart Citations

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

Butz²,

et al. 2013

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“…5 Practice coaches were used, a spirometer was given to the practices, and an interactive voice response program was created and provided. Through this ambitious program, these practices reported large increases in their appropriate diagnosis and management of asthma.…”

Section: Asthma Smoking and Steroid Dosingmentioning

confidence: 99%

Exciting Research Studies on Practical Medical Problems and Health Services Delivery

Bowman¹,

Neale²

2011

The Journal of the American Board of Family Medicine

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Major articles with major findings are in this issue. Patient-centered medical care is associated with large decreases in medical care costs! Pelvic examinations can lead to increased symptoms and infections. What should we do? Maternal postpartum depression is related to poorer infant health care quality of life at least until 16 months of age, but cannot be detected until well into the immediate postpartum time period. Using the Colorado Asthma toolkit, practices can significantly improve their management of asthma. Smoking has implications for asthma and its management. Healthy patients often do not understand their insurance, nor why they need it if they are healthy. Younger women are not aware of the potential teratogenic harms of their diabetes and hypertension medicines. Insomnia patients often will accept behavioral treatments. A health literacy screening was not of much practical help in one office. Obesity should be a documented medical problem and is an accepted topic for group medical visits. Patient-Centered Care Lowers Medical CostsNews flash: patient-centered care is associated with less use of health care services and lower medical expenditures.1 There was a fairly dramatic difference in charges: 50%. When controlling for multiple other factors, more patient-centered care was associated with a 15% (for women patients) and 31% (for men) decrease in cost over the ensuing year; it is interesting to note the sex difference. Impressively, the decreased utilization was diffuse across specialty visits, ancillary testing, and even hospitalization despite the relatively small number of patients (n ϭ 509). The physicians were secondand third-year residents, so perhaps the differences would not be as great if they were attending physicians. Increasing the ability of physicians to provide patient-centered care could decrease costs, providing more dollars to care for those who are currently underserved. What Are the Negative Effects of a Pelvic Examination?What about urinary symptoms or urinary tract or vaginal infections? We do so many pelvic exams, but mostly we think of emotional consequences, such as women fearing the examination itself or the possible results (diagnosis of sexually transmitted diseases or an abnormal Papanicolaou smear). However, Tiemstra et al 2,3 present new data that suggest that women have more urinary symptoms (prospective and retrospective study), more vaginal symptoms (retrospective study), and are more likely to have actual urinary tract infections (retrospective chart review). The authors' points were reinforced when I (MAB) recently saw 2 patients with urinary tract infections that they blamed on recent pelvic exams. More study needs to be done, but these results are intriguing and suggest we need more work on whether pelvic exams cause problems and how to prevent such negative outcomes.

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Improving Asthma Care in Rural Primary Care Practices: A Performance Improvement Project

Cicutto

Dingae

Langmack

2014

Journal of Continuing Education in the Health Professions

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The Colorado Asthma Toolkit Program: A Practice Coaching Intervention from the High Plains Research Network

Cited by 35 publications

References 28 publications

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

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

Exciting Research Studies on Practical Medical Problems and Health Services Delivery

Improving Asthma Care in Rural Primary Care Practices: A Performance Improvement Project

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