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1 RAND Health, Santa Monica, Calif
2 Department of Pediatrics, University of California, Los Angeles, Calif
3 Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
CORRESPONDING AUTHOR: Matthias Schonlau, PhD, RAND, 201 N Craig St, Suite 202, Pittsburgh, PA 15213, matt{at}rand.org
PURPOSE We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults.
METHOD 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.
Key Words: Asthma • evaluation studies • chronic disease • breakthrough series collaborative • chronic care model • process of care • outcomes and process assessment (health care)
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