Impact of a quality improvement program on care and outcomes for children with asthma.
OBJECTIVE
To test a quality improvement intervention, a learning collaborative based on the Institute for Healthcare Improvement's Breakthrough Series methodology, specifically intended to improve care and outcomes for patients with childhood asthma.


METHODS
Randomized trial in primary care practices.


METHODS
Practices in greater Boston, Mass, and greater Detroit, Mich.


METHODS
Forty-three practices, with 13 878 pediatric patients with asthma, randomized to intervention and control groups. Intervention Participation in a learning collaborative project based on the Breakthrough Series methodology of continuous quality improvement.


METHODS
Change from baseline in the proportion of children with persistent asthma who received appropriate medication therapy for asthma, and in the proportion of children whose parent received a written management plan for their child's asthma, as determined by telephone interviews with parents of 631 children.


RESULTS
After adjusting for state, practice size, child age, sex, and within-practice clustering, no overall effect of the intervention was found.


CONCLUSIONS
This methodologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on processes or outcomes of care for children with asthma. Potential deficiencies in program implementation, project duration, sample selection, and data sources preclude making the general inference that this type of improvement program is ineffective. Additional rigorous studies should be undertaken under more optimal settings to assess the efficacy of this method for improving care.
Homer
Charles J
CJ
National Initiative for Children's Health Care Quality, 375 Longwood Avenue, 3rd Floor, Boston, MA 02215, USA. chomer@nichq.org
Forbes
Peter
P
Horvitz
Lisa
L
Peterson
Laura E
LE
Wypij
David
D
Heinrich
Patricia
P
D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008824:Michigan; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D011787:Quality of Health Care; D016896:Treatment Outcome