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?

Mangione-Smith, Rita; Schonlau, Matthias; Chan, Kitty S.; Keesey, Joan; Rosen, Mayde; Louis, Thomas A.; Keeler, Emmett

doi:10.1367/A04-106R.1

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Volume 5, Issue 2 , Pages 75-82, March 2005

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?

Rita Mangione-Smith, MD, MPH
- Address correspondence to Rita Mangione-Smith, MD, MPH, UCLA Department of Pediatrics, 10833 LeConte Ave, Los Angeles, CA 90095-1752
Matthias Schonlau, PhD
- From the Department of Pediatrics (Dr Mangione-Smith), University of California, Los Angeles, Calif; RAND Health (Dr Schonlau, Ms Keesey, Ms Rosen, Dr Keeler), Santa Monica, Calif; and the Bloomberg School of Public Health (Drs Chan and Louis), Johns Hopkins University, Baltimore, Md
Kitty S. Chan, PhD
- From the Department of Pediatrics (Dr Mangione-Smith), University of California, Los Angeles, Calif; RAND Health (Dr Schonlau, Ms Keesey, Ms Rosen, Dr Keeler), Santa Monica, Calif; and the Bloomberg School of Public Health (Drs Chan and Louis), Johns Hopkins University, Baltimore, Md
Joan Keesey, BA
- From the Department of Pediatrics (Dr Mangione-Smith), University of California, Los Angeles, Calif; RAND Health (Dr Schonlau, Ms Keesey, Ms Rosen, Dr Keeler), Santa Monica, Calif; and the Bloomberg School of Public Health (Drs Chan and Louis), Johns Hopkins University, Baltimore, Md
Mayde Rosen, RN, BSN
- From the Department of Pediatrics (Dr Mangione-Smith), University of California, Los Angeles, Calif; RAND Health (Dr Schonlau, Ms Keesey, Ms Rosen, Dr Keeler), Santa Monica, Calif; and the Bloomberg School of Public Health (Drs Chan and Louis), Johns Hopkins University, Baltimore, Md
Thomas A. Louis, PhD
- From the Department of Pediatrics (Dr Mangione-Smith), University of California, Los Angeles, Calif; RAND Health (Dr Schonlau, Ms Keesey, Ms Rosen, Dr Keeler), Santa Monica, Calif; and the Bloomberg School of Public Health (Drs Chan and Louis), Johns Hopkins University, Baltimore, Md
Emmett Keeler, PhD
- From the Department of Pediatrics (Dr Mangione-Smith), University of California, Los Angeles, Calif; RAND Health (Dr Schonlau, Ms Keesey, Ms Rosen, Dr Keeler), Santa Monica, Calif; and the Bloomberg School of Public Health (Drs Chan and Louis), Johns Hopkins University, Baltimore, Md

Received 6 July 2004; accepted 31 October 2004.

Objective.—To examine whether a collaborative to improve pediatric asthma care positively influenced processes and outcomes of that care.

Methods.—Medical record abstractions and patient/parent interviews were used to make pre- and postintervention comparisons of patients at 9 sites that participated in the evaluation of a Breakthrough Series (BTS) collaborative for asthma care with patients at 4 matched control sites.

Setting.—Thirteen primary care clinics.

Patients.—Three hundred eighty-five asthmatic children who received care at an intervention clinic and 126 who received care at a control clinic (response rate = 76%).

Intervention.—Three 2-day educational sessions for quality improvement teams from participating sites followed by 3 “action” periods over the course of a year.

Results.—The overall process of asthma care improved significantly in the intervention group but remained unchanged in the control group (change in process score +13% vs 0%; P < .0001). Patients in the intervention group were more likely than patients in the control group to monitor their peak flows (70% vs 43%; P < .0001) and to have a written action plan (41% vs 22%; P = .001). Patients in the intervention group had better general health-related quality of life (scale score 80 vs 77; P = .05) and asthma-specific quality of life related to treatment problems (scale score 89 vs 85; P < .05).

Conclusions.—The intervention improved some important aspects of processes of care that have previously been linked to better outcomes. Patients who received care at intervention clinics also reported higher general and asthma-specific quality of life.

KEY WORDS: asthma , Breakthrough Series collaborative , chronic care model , quality improvement