Evaluation of a quality improvement collaborative in asthma care: does it improve processes and outcomes of care?
OBJECTIVE
We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults.


METHODS
We undertook a preintervention-postintervention evaluation of 185 patients in 6 intervention clinics and 3 matched control sites that participated in the Institute for Healthcare Improvement Breakthrough Series (BTS) Collaborative for asthma care. The intervention consisted of 3, 2-day educational sessions for teams dispatched by participating sites, which were followed by 3 action periods during the course of a year.


RESULTS
Overall process of asthma care improved significantly in the intervention compared with the control group (change of 10% vs 1%, P = .003). Patients in the intervention group were more likely to attend educational sessions (20% vs 5%, P = .03). Having a written action plan, setting goals, monitoring peak flow rates, and using long-term asthma medications increased between 2% and 19% (not significant), but asthma-related knowledge was unchanged for the 2 groups. Patients in the BTS Collaborative were significantly more likely to be satisfied with clinician and lay educator communication (62% vs 39%, P = .02). Health-related quality of life, asthma-specific quality of life, number of bed days caused by asthma-related illness, and acute care service use were not significantly different between the 2 groups.


CONCLUSIONS
The intervention was associated with improved process-of-care measures that have been linked with better outcomes. Patients benefited through increased satisfaction with communication. Follow-up of patients who participated in the intervention may have been too brief to be able to detect significant improvement in health-related outcomes.
Schonlau
Matthias
M
RAND Health, Santa Monica, Calif., USA. matt@rand.org <matt@rand.org>
Mangione-Smith
Rita
R
Chan
Kitty S
KS
Keesey
Joan
J
Rosen
Mayde
M
Louis
Thomas A
TA
Wu
Shin-Yi
SY
Keeler
Emmett
E
D000328:Adult; D001249:Asthma / Q000628:therapy*; D002648:Child; D003299:Cooperative Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires; D014481:United States