title: Improving asthma care in rural primary care practices: a performance improvement project.
abstract: BACKGROUND
  Rural areas are often underserviced health areas, lack specialty care services, and experience higher levels of asthma-related burden. A primary care, asthma-focused, performance improvement program was provided to a 6-county, rural-frontier region in Colorado to determine whether asthma care practices could be enhanced to become concordant with evidence-based asthma care guidelines.
  
  
  METHODS
  A pre-post, quasi-experimental design was used. A complex, multifaceted intervention was provided to multidisciplinary primary care teams in practices serving children and adults with asthma. Intervention elements included face-to-face trainings, clinical support tools, patient education materials, a website, and clinic visits. Performance improvement and behavior change indicators were collected through chart audits and surveys from the entire health care team.
  
  
  RESULTS
  Participants included three health care organizations and their staff in 13 primary care practices. Overall, all team members reported statistically significant improvements in confidence levels for providing quality asthma care. Chart reviews of asthma patient encounters completed before and after the program demonstrated statistically significant improvements in asthma care practices for asthma control assessment (1% vs 20%), provision of asthma action plans (2% vs 29%), controller prescription (39% vs 71%), inhaler technique assessment (1% vs 18%), and arrangement of follow-up appointment (20% vs 37%).
  
  
  CONCLUSIONS
  The asthma care-focused, multifaceted, complex, performance improvement intervention provided to rural primary health care teams lead to significant improvements in all indicators of quality asthma care provision to adults and children with asthma. However, significant barriers exist for rural practices to adopt evidence-based asthma care practices.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cicutto
authors.forename: Meg B
authors.initials: MB
authors.lastname: Dingae
authors.forename: Esther L
authors.initials: EL
authors.lastname: Langmack
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D004496:Education, Continuing / Q000379:methods / Q000458:organization & administration / Q000592:standards; D055317:Evidence-Based Practice / Q000193:education* / Q000592:standards; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards / Q000639:trends; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards*; D000078329:Workforce; D055815:Young Adult
keywords: asthma; experimental/quasi-experimental design; interprofessional education; performance improvement CE; primary care; rural