Measuring the effectiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processes and outcomes of care?
OBJECTIVE
To examine whether a collaborative to improve pediatric asthma care positively influenced processes and outcomes of that care.


METHODS
Medical record abstractions and patient/parent interviews were used to make pre- and postintervention comparisons of patients at 9 sites that participated in the evaluation of a Breakthrough Series (BTS) collaborative for asthma care with patients at 4 matched control sites.


METHODS
Thirteen primary care clinics.


METHODS
Three hundred eighty-five asthmatic children who received care at an intervention clinic and 126 who received care at a control clinic (response rate = 76%).


METHODS
Three 2-day educational sessions for quality improvement teams from participating sites followed by 3 "action" periods over the course of a year.


RESULTS
The overall process of asthma care improved significantly in the intervention group but remained unchanged in the control group (change in process score +13% vs 0%; P < .0001). Patients in the intervention group were more likely than patients in the control group to monitor their peak flows (70% vs 43%; P < .0001) and to have a written action plan (41% vs 22%; P = .001). Patients in the intervention group had better general health-related quality of life (scale score 80 vs 77; P = .05) and asthma-specific quality of life related to treatment problems (scale score 89 vs 85; P < .05).


CONCLUSIONS
The intervention improved some important aspects of processes of care that have previously been linked to better outcomes. Patients who received care at intervention clinics also reported higher general and asthma-specific quality of life.
Mangione-Smith
Rita
R
Department of Pediatrics, University of California, Los Angeles, CA 90095-1752, USA. ritams@ucla.edu
Schonlau
Matthias
M
Chan
Kitty S
KS
Keesey
Joan
J
Rosen
Mayde
M
Louis
Thomas A
TA
Keeler
Emmett
E
D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D011788:Quality of Life; D016896:Treatment Outcome