title: Improving pediatric asthma control among minority children participating in medicaid: providing practice redesign support to deliver a chronic care model.
abstract: BACKGROUND
  Asthma, a leading chronic disease of children, currently affects about 6.2 million (8.5%) children in the United States. Despite advances in asthma research and availability of increasingly effective therapy, many children do not receive appropriate medications to control the disease, have over-reliance on reliever medication, and lack systematic follow-up care. The situation is even worse for poor inner-city and minority children who have significantly worse asthma rates, severity, and outcomes. National Asthma Education and Prevention Program Guidelines recommend a multimodal, chronic care approach.
  
  
  OBJECTIVE
  The authors assessed the effectiveness of practice redesign and computerized provider feedback in improving both practitioner adherence to National Asthma Education and Prevention Program Guidelines (NAEPP), and patient outcomes in 295 poor minority children across four Federally Qualified Health Centers (FQHC).
  
  
  METHODS
  In a nonrandomized, two-group (intervention versus comparison), two-phase trial, all sites were provided redesign support to provide quarterly well-asthma visits using structured visit forms, community health workers for outreach and follow-up, a Web-based disease registry for tracking and scheduling, and a provider education package. Intervention sites were given an additional Web-based, computerized patient-specific provider feedback system that produced a guideline-driven medication assessment prompt.
  
  
  RESULTS
  Logistic regression results showed that providers at intervention sites were more than twice as likely on average to prescribe guideline-appropriate medications after exposure to our feedback system during the Phase I enrollment period than providers at comparison sites (exp(B) = 2.351, confidence interval [CI] = 1.315-4.204). In Phase II (the post-enrollment visit period), hierarchical linear models (HLMs) and latent growth curves were used to show that asthma control improved significantly by .19 (SE = .05) on average for each of the remaining four visits (about 11% of a standard deviation), and improved even more for patients at intervention sites. These results show that implementation of practice redesign support guided by a pediatric chronic care model can improve provider adherence to treatment guidelines as well as patients' asthma control.
  
  
  CONCLUSIONS
  The addition of patient-specific feedback for providers results in quicker adoption of guideline recommendations and potentially greater improvements in asthma control compared to the basic practice redesign support alone.
authors.affiliation: Department of Family Medicine, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030, USA. fifield@nso1.uchc.edu
authors.forename: Judith
authors.initials: J
authors.lastname: Fifield
authors.forename: Julia
authors.initials: J
authors.lastname: McQuillan
authors.forename: Melanie
authors.initials: M
authors.lastname: Martin-Peele
authors.forename: Vitaly
authors.initials: V
authors.lastname: Nazarov
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: Thomas
authors.initials: T
authors.lastname: Babor
authors.forename: Joseph
authors.initials: J
authors.lastname: Burleson
authors.forename: Robert
authors.initials: R
authors.lastname: Cushman
authors.forename: Jeri
authors.initials: J
authors.lastname: Hepworth
authors.forename: Eric
authors.initials: E
authors.lastname: Jackson
authors.forename: Susan
authors.initials: S
authors.lastname: Reisine
authors.forename: Joseph
authors.initials: J
authors.lastname: Sheehan
authors.forename: Joan
authors.initials: J
authors.lastname: Twiggs
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D017410:Practice Guidelines as Topic; D012107:Research Design; D014481:United States