A Randomized Clinical Trial of Clinician Feedback to Improve Quality of Care for Inner-city Children With Asthma

Kattan, Meyer; Crain, Ellen F.; Steinbach, Suzanne; Visness, Cynthia M.; Walter, Michelle; Stout, James; Evans, Richard; Smartt, Ernestine; Gruchalla, Rebecca S.; Morgan, Wayne J.; O’Connor, George T.; Mitchell, Herman

doi:10.1542/peds.2005-2160

Cited by 64 publications

(99 citation statements)

References 35 publications

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“…37,96 Several studies included children. 5,37,46,85,96 Nine studies reported a reduction in ED visits or hospitalizations 5,[36][37][38]46,84,85,95,96 (5%-60%) among pre-post studies (all statistically significant) and 1% to 7% among the RCTs. 5,37,95 SOE: moderate.…”

Section: Clinical Pharmacy Supportmentioning

confidence: 97%

“…94 95 supplemental feedback protocols, 5 and structured pathways/algorithms. 37,96 Several studies included children.…”

Section: Clinical Pharmacy Supportmentioning

confidence: 99%

“…2 A number of guidelines have been published (eg, the National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, also known as EPR-3 3 ), and following guideline treatment recommendations improves clinical outcomes. [4][5][6] However, health care providers do not routinely follow asthma guideline recommendations, 7,8 resulting in substandard care and poor health outcomes. [9][10][11][12][13][14] One of the shortcomings of asthma guidelines is the limited extent to which health care providers are provided with tools to follow the recommended care.…”

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confidence: 99%

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Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Butz²,

et al. 2013

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BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers' adherence to asthma guidelines on health care process and clinical outcomes. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-forperformance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. METHODS:CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. Pediatrics 2013;132:517-534

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Section: Clinical Pharmacy Supportmentioning

confidence: 97%

“…94 95 supplemental feedback protocols, 5 and structured pathways/algorithms. 37,96 Several studies included children.…”

Section: Clinical Pharmacy Supportmentioning

confidence: 99%

mentioning

confidence: 99%

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Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Butz²,

et al. 2013

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“…Kattan et al described a program where clinical information, including medications use, was collected from patients and their families, and then provided to their primary care physician in conjunction with recommendations for medication changes. 18 This resulted in a significant increase in appropriate stepping up of asthma therapy (46% of visits) compared to a control group (35.6% of visits). Lee et al studied the impact of providing a review of individual patient medications in addition to educational material: although there was a drop in SABA use from 300 to 200 puffs per month, there was no change in clinical outcomes as measured by emergency visits and asthma related hospitalisation.…”

Section: Impact Of Strategies To Improve Prescribingmentioning

confidence: 99%

“…No difference between groups in airway hyperresponsiveness (p=0.09), improvement in nocturnal symptoms groups A and C No physician outcomes reported de Vries et al 18 Increase number of children with SABA prescriptions (p<0.01), fewer children on LABA with no ICS (p=0.03) (positive change)…”

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confidence: 98%

A review of strategies to improve rational prescribing in asthma

et al. 2014

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Prompting Asthma Intervention in Rochester–Uniting Parents and Providers (PAIR-UP)

et al. 2014

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Importance disproportionate number of impoverished and minority children suffer from asthma and receive suboptimal preventive care. Objective To evaluate whether the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers (PAIR-UP) intervention, administered in primary care offices, improves the delivery of preventive care and reduces morbidity for urban children with asthma. Design Cluster randomized trial. Setting Twelve urban primary care practices in Rochester, NY, matched based on size/type and randomly allocated to ‘PAIR-UP’' or 'usual care (UC)'. Participants Children (2–12yrs) with persistent or poorly controlled asthma, enrolled in the waiting room prior to a visit with a provider for any reason. Interventions Children enrolled at PAIR-UP practices received prompts for the caregiver and healthcare provider at the time of the visit, which outlined the child's asthma severity/control and specific guideline-based recommendations to enhance preventive care. These practices also received educational resources and periodic feedback on their asthma care performance. UC practices received copies of the asthma guidelines. Main Outcomes and Measures Blinded interviewers called caregivers within 2 weeks to inquire about preventive measures taken at the visit, and 2 and 6 months later to assess symptoms. The primary outcome was symptom-free days (SFDs)/2 week sat the 2-month follow-up. We used Weighted Generalized Estimating Equation to estimate the intervention effect, adjusting for clustering and confounding variables. Results We enrolled 638 children (participation rate:80%, 36% Black, 36% Hispanic, 68% Medicaid). Groups were similar in demographics and asthma severity at baseline. At the time of the visit, more children in PAIR-UP received a preventive medication action (new medication or increased dose) compared to UC (58%vs.33%; OR:2.8, 95%CI;1.9,3.9). Further, more PAIR-UP children received an asthma action plan (61%vs.23%; OR:8.3, 95%CI;3.7,18.7), discussions regarding asthma (93%vs.78%; OR:4.5, 95%CI;2.8,7.2), and secondhand smoke counseling (80%vs.63%; OR:2.6, 95%CI;1.2,5.5). At the 2 month follow-up, children in PAIR-UP had more SFDs/2 weeks compared to UC (mean difference 0.78 days, 95%CI;0.29,1.27). At 6 months, the improvement in SFDs was no longer statistically significant (mean difference 0.56, 95%CI;–0.14,1.25). Conclusions and Relevance PAIR-UP improved the delivery of preventive asthma care and reduced asthma morbidity for high-risk urban children with persistent asthma.

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A Randomized Clinical Trial of Clinician Feedback to Improve Quality of Care for Inner-city Children With Asthma

Abstract: Patient-specific feedback to inner-city providers increased scheduled asthma visits, increased asthma visits in which medications were stepped up when clinically indicated, and reduced emergency department visits.

Cited by 64 publications

References 35 publications

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

A review of strategies to improve rational prescribing in asthma

Prompting Asthma Intervention in Rochester–Uniting Parents and Providers (PAIR-UP)

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