Adult asthma disease management: an analysis of studies, approaches, outcomes, and methods.
BACKGROUND
Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies.


METHODS
We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods.


RESULTS
Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective.


CONCLUSIONS
Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.
Maciejewski
Matthew L
ML
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27701, USA. mlm34@duke.edu
Chen
Shih-Yin
SY
Au
David H
DH
D000328:Adult; D001249:Asthma / Q000628:therapy*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D019468:Disease Management; D006801:Humans; D011787:Quality of Health Care; D012107:Research Design