Measuring the Effectiveness of a Collaborative for Quality Improvement in Pediatric Asthma Care: Does Implementing the Chronic Care Model Improve Processes and Outcomes of Care?
Section snippets
METHODS
To evaluate whether the ICIC BTS collaborative to improve pediatric asthma care positively influenced processes and outcomes, we conducted a controlled pre- and postintervention study. The ICIC BTS collaborative for asthma began February 15, 2000, and ended March 1, 2001. Twenty-six geographically dispersed health care organizations participated in the collaborative. Twenty-four of the organizations provided care to children and adolescents, and 9 of these organizations agreed to take part in
Population Characteristics
We obtained survey data from parents of 385 children (296 aged 2–11 years, 89 aged 12–17 years) who received care at an intervention clinic and 126 children (70 aged 2–11 years and 56 aged 12–17 years) who received care in a control clinic (response rate = 76%, using AAPOR definition RR4).27 Of those surveyed, 216 parents from the intervention group (56%) and 88 of the parents from the control group (70%) also agreed to have their child's medical record abstracted, as did an additional 132
DISCUSSION
Children receiving care from clinics participating in the BTS collaborative for asthma care had significant improvements in processes of care and had better scores on 2 quality-of-life measures after the intervention was completed. Considering that most of the clinics participating in this BTS collaborative were Bureau of Primary Healthcare centers, the improvements observed are somewhat surprising, given their limited resources and the difficult environment in which these centers operate. In a
LIMITATIONS
Unfortunately, obtaining the approval of multiple local Institutional Review Boards and consent to contact patients took longer then anticipated. As a result, the survey data constitute a purely cross-sectional study conducted after groups participated in the collaborative. Thus, the higher scores on HRQoL measures for the intervention group cannot be interpreted as an improvement in outcomes. However, the chart review found no differences between the intervention and control groups in
CONCLUSIONS
This BTS collaborative implementing the chronic care model to improve asthma care had a positive impact on important processes of care and patient self-management practices that have previously been linked to improved health outcomes. However, studies that are large enough to see gains in health outcomes from quality improvement may have to be conducted in large health care systems that already have patient consent for quality improvement data collection and electronic clinical data.
ACKNOWLEDGMENT
We are grateful for the support of The Robert Wood Johnson Foundation, which funded this work through grants 034984 and 035678.
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