title: Modification of provider behavior to achieve improved asthma outcomes.
abstract: Despite an abundance of scientific evidence supporting the use of guidelines, adherence to asthma practice guidelines by physicians generally is low, regardless of provider and patient characteristics. As a result, scientific information, obtained with great effort and at huge expense, is not being translated into clinical practice. To remedy this, we developed a disease management program that emphasizes alteration of provider behavior using operant conditioning. We did this by placing asthma educators in private offices for up to 8 weeks. The educators used a combination of problem-based learning, role modeling, and operant conditioning with positive reinforcement to affect behavior change. As a result of these behavior changes, by the end of 8 weeks the cost to treat asthma patients decreased, despite an increase in the cost of medications. We concluded that behavior-oriented programs targeted at provider offices can lead to improved asthma care while reducing costs.
authors.affiliation: Section of Allegy, Asthma & Immunology, Children's Mercy Hospital, Kansas City, MO 64108, USA. emjones@cmh.edu
authors.forename: Erika M
authors.initials: EM
authors.lastname: Jones
authors.forename: Jay M
authors.initials: JM
authors.lastname: Portnoy
mesh_terms: D001249:Asthma / Q000628:therapy*; D001291:Attitude of Health Personnel; D003216:Conditioning, Operant; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'