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