Elsevier

Academic Pediatrics

Volume 11, Issue 1, January–February 2011, Pages 58-65
Academic Pediatrics

Quality Improvement and Clinical
Quality Improvement for Asthma Care Within a Hospital-Based Teaching Clinic

https://doi.org/10.1016/j.acap.2010.10.004Get rights and content

Abstract

Objective

The aim of this study was to determine if a quality improvement intervention in a teaching clinic was associated with the following: 1) improved asthma action plan creation and distribution, 2)increased classification of asthma patients as intermittent or persistent, 3) increased prescriptions of asthma controller medications, 4) decreased emergency department visits and hospitalizations, and 5) sustainable changes in outcomes after the intervention year.

Methods

A retrospective analysis was conducted of a quality improvement project involving children aged >2 years who were diagnosed with asthma, evaluated in a large hospital-based teaching clinic. Outcomes were assessed for 1 year before and 3 years after quality improvement intervention.

Results

Data from children with asthma seen in the clinic over the 4 years of the study (N = 1797) were analyzed. Mixed effects model regressions showed that children after the intervention were over twofold more likely to receive an asthma action plan (using 2006 as referent, adjusted risk ratio [ARR] 2.29, 95% confidence interval [CI] 2.03–2.56 in 2007; ARR 2.40, 95% CI 2.15–2.66 in 2008; ARR 2.86, 95% CI 2.60–3.20 in 2009). Recorded assessment of asthma severity was 31% to 47% more likely post-intervention (ARR 1.31, 95% CI 1.26–1.36 in 2007, ARR 1.44 95% CI 1.38–1.50 in 2008, ARR 1.47 95% 1.41–1.54 in 2009). Controller medication prescribing increased postintervention ARR 1.08, 95% CI, 1.02–1.14 in 2007; ARR 1.11, 95% CI, 1.04–1.17 in 2008; ARR 1.11, 95% CI, 1.05–1.19 in 2009. Emergency department visits and hospitalizations trended lower postintervention (not significant).

Conclusions

A quality improvement intervention in a hospital-based teaching clinic was associated with increased use of asthma action plans, classification of asthma severity, and controller medications, and possibly a trend toward fewer emergency visits and hospitalizations.

Section snippets

Study Design

This was a retrospective study, and outcomes were assessed from an electronic medical records (EMRs), paper chart reviews, and administrative data for children seen in the Child Health Clinic (CHC) for asthma, or who were given a dose of albuterol. Data were gathered and collected over the year before the implementation (2006) and for 3 years after the program started (2007–2009).

Study Setting

The study was conducted in the CHC at The Children’s Hospital, Denver, Colorado, a large hospital-based teaching

Study Population

The total number of children seen in the CHC who met the inclusion criteria for the study in each year, along with gender, age, ethnicity, language, and insurance, are shown in Table 1. Approximately 700 patients were seen at the CHC in each year of the study, with female predominance, 90% of the patients under the age of 13, with mostly English as their primary language, and with Medicaid or no insurance. Table 2 shows clinical characteristics of the patients in the 4 years of the study

Discussion

This is one of the first published studies to show improved asthma outcomes in a pediatric hospital-based teaching clinic after a comprehensive quality improvement intervention. Implementation of this quality improvement intervention was associated with increased compliance with the national asthma care guidelines. The creation of asthma action plans, the assignment of asthma severity, and prescriptions for controller medications all increased significantly.

The apparent trend toward fewer

Conclusion

Implementation of this quality improvement intervention in a hospital-based teaching clinic was associated with increased asthma action plan creation, increased classification of asthma severity, controller prescriptions, and possibly decreased emergency department visits and hospitalizations. These results suggest that even in a high-turnover teaching clinic with a high-risk population, collaborative practice change can be achieved with demonstrable and sustainable effects on important

Acknowledgments

We gratefully acknowledge Children's Outcomes Research and The Children’s Hospital, Aurora, Colorado, for their kind support of this research. We appreciate the contribution of SAS code by Dr Lawrence C. Kleinman and Professor Edward C. Norton to assist with the regression risk analysis. We would like to thank Renee Oxley for assistance with the conceptual model, The Children's Hospital and Children's Outcomes Research for funding this project, and the staff, faculty and trainees in the Child

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