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Tables
Variable Intervention n = 123 Control n = 62 Overall n = 185 PValue Note: P values stem from χ2 tests for categorical variables and from t tests for age. To avoid nearly empty or empty cells for the χ2 tests, cells with 4 or more comorbidities were combined. Age, y, mean (SD) 42.3 (17.4) 43.9 (15.7) 42.8 (16.8) .53 Male, % 17.9 24.2 20 .31 Respondent’s education, % – – – .55 < High school 29.3 23.0 27.2 – High school 29.3 27.9 28.8 – > High school 41.5 49.2 44.0 – Household income ≥ $30,000, % 26.8 22.6 28.9 .53 Race or ethnicity, % – – – .32 White (non-Hispanic) 65.9 75.8 69.2 – Hispanic 17.1 9.7 14.6 – Black (non-Hispanic) 5.7 8.1 6.5 – Other + multiracial + Asian 11.4 6.5 9.7 – Comorbidities, No., mean (SD) 1.32 (1.23) 2.08 (1.53) 1.57 (1.38) .007 Asthma severity, % – – – .11 Intermittent 33.9 43.9 40.5 – Persistent (mild) 19.4 25.2 23.2 – Persistent (moderate or severe) 46.8 30.9 36.2 – No insurance, % 9.8 8.1 9.2 .70 - Table 2.
Adjusted Difference of Differences for the Intervention and Control Groups for Each Quality Indicator Based on Medical Record Abstractions
Intervention Group (n = 101) Control Group (n = 64) Quality Indicator Final Passing (%) Change From Initial (%) Final Passing (%) Change From Initial (%) Adjusted Differences of Differences AdjustedPValue for Differences of Differences * Significant at P <.05. † Significant at P <.01. 1. All patients should have a β2-agonist prescribed for symptomatic relief 83 2 89 6 −4 .68 2. Peak expiratory flow rate (or spirometry) should be measured in all patients at least annually 28 21 14 0 17 .03* 3. No β-blocker should be prescribed for patients with diagnosed asthma 92 −2 92 −2 0 .94 4. All patients should have a written action plan in the medical record based on changes in symptoms or peak flow measurements 27 26 0 0 26 <.0001† 5. Patients with asthma should have at least 2 routine planned follow-up visits for asthma annually 77 −8 91 2 −7 .41 6. Patients should be educated by physician in self-management of asthma 37 15 10 −3 15 .07 7. Patients prescribed inhaled medications should be instructed in use of metered- dose inhalers 22 15 7 7 13 .04 8. Evidence of collaborative goal setting between patient and clinician and lay educator should be recorded at least annually 7 7 0 0 7 .03* 9. Overall asthma process of care summary score 46 10 38 1 8 .003† - Table 3.
Adjusted and Unadjusted Survey-Based Process-of-Care Measures for Patients in Control and Intervention Groups
Unadjusted Adjusted* Variables Control (n = 62) Intervention (n = 123) Difference Control (n = 62) Intervention (n = 123) Difference PValue * Adjustments are based on multiple regressions adjusted for race/ethnicity, education, sex, income, severity of asthma, and number of comorbidities. † Significant at P <.05. Patient self-management, % Peak flow monitoring 38 60 23 44 57 13 .21 Goal setting 40 53 13 47 50 3 .74 Written action plan 24 43 19 25 44 19 .058 Education sessions attended 2 11 10 5 20 15 .028† Knowledge (0–10 scale) 7.7 7.5 −0.2 7.6 7.6 0.0 .93 Taking long-term medication (yes/no), % 66 70 4 67 69 2 .85 - Table 4.
Comparison Between Various Survey-Based Outcomes Measures of Patients in Control Groups and Patients in Breakthrough Series Collaborative Intervention
Outcome Control (n = 123) Intervention (n = 62) Difference PValue * Scale between 0 and 10 where 0 is best (no impact) and 10 is worst (large impact). † Significant at P <.05. General quality of life 39 40 2 .29 Asthma-specific quality of life* 4 4 0 .73 Satisfaction with clinician and lay educator communication 39 62 23 .02† Number of emergency department visits and hospital admissions 1 2 1 .08 Number of days in bed due to asthma-related illness 2 2 0 .77
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The Article in Brief
Background: The purpose of this study was to examine the effectiveness of an asthma care program that involved collaboration between health care organizations around the United States. The program was designed to improve processes for delivering care to asthma patients.
What This Study Found: A national collaborative asthma care program can significantly improve processes of care. Participating patients are more likely than other patients to attend educational sessions and are more satisfied with communications with their clinicians. They also use more written action plans, goal-setting, peak flow monitoring, and long-term controller medications. There was not an improvement in patients� quality of life or a decrease in hospitalizations for asthma.
Implications:
* Other research has shown that improving care processes, attending educational sessions, goal-setting, and peak flow monitoring can improve the health of asthma patients
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