Quality improvement strategies for children with asthma: a systematic review.
OBJECTIVE
To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care.


METHODS
Cochrane Effective Practice and Organisation of Care Group database (January 1966 to April 2006), MEDLINE (January 1966 to April 2006), Cochrane Consumers and Communication Group database (January 1966 to May 2006), and bibliographies of retrieved articles.


METHODS
Randomized controlled trials, controlled before-after trials, or interrupted time series trials of English-language QI evaluations.


METHODS
Must have included 1 or more QI strategies for the outpatient management of children with asthma.


METHODS
Clinical status (eg, spirometric measures); functional status (eg, days lost from school); and health services use (eg, hospital admissions).


RESULTS
Seventy-nine studies met inclusion criteria: 69 included at least some component of patient education, self-monitoring, or self-management; 13 included some component of organizational change; and 7 included provider education. Self-management interventions increased symptom-free days by approximately 10 days/y (P = .02) and reduced school absenteeism by about 0.1 day/mo (P = .03). Interventions of provider education and those that incorporated organizational changes were likely to report improvements in medication use. Quality improvement interventions that provided multiple educational sessions, had longer durations, and used combinations of instructional modalities were more likely to result in improvements for patients than interventions lacking these characteristics.


CONCLUSIONS
A variety of QI interventions improve the outcomes and processes of care for children with asthma. Use of similar outcome measures and thorough descriptions of interventions would advance the study of QI for pediatric asthma care.
Bravata
Dena M
DM
Center for Primary Care and Outcomes Research, Stanford, CA 94305-6019, USA. dbravata@stanford.edu
Gienger
Allison L
AL
Holty
Jon-Erik C
JE
Sundaram
Vandana
V
Khazeni
Nayer
N
Wise
Paul H
PH
McDonald
Kathryn M
KM
Owens
Douglas K
DK
D000041:Absenteeism; D000553:Ambulatory Care / Q000458:organization & administration; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000175:diagnosis / Q000534:rehabilitation*; D002648:Child; D018849:Controlled Clinical Trials as Topic; D003695:Delivery of Health Care / Q000458:organization & administration; D004493:Education / Q000458:organization & administration; D006293:Health Promotion; D006760:Hospitalization; D006801:Humans; D009330:Nebulizers and Vaporizers; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D012648:Self Care
D018927:Anti-Asthmatic Agents