A randomized controlled trial of an asthma clinical pathway for children in general practice

Mitchell, Ed; Didsbury, PB; Kruithof, Nena; Robinson, Elizabeth; Milmine, M.; Mj, Barry; Newman, Jack

doi:10.1080/08035250410020235

Cited by 34 publications

(25 citation statements)

References 5 publications

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“…94 95 supplemental feedback protocols, 5 and structured pathways/algorithms. 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.…”

Section: Clinical Pharmacy Supportmentioning

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: 99%

“…Fifteen studies were identified that included the provision of asthma guidelines in a more accessible format (eg, "pocket" versions), [36][37][38] use of a specific algorithm, pathway, or flow sheet, 37 …”

Section: Decision Supportmentioning

confidence: 99%

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

Butz²,

et al. 2013

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“…A number of studies reported substantial improvement in quality both in inpatient [1,11,14,18,21,32,50,53,57,60,62,68,78] and outpatient settings [13,29,37,40,42,46]. Numerous studies, including six RCTs [4,7,38,51,63,71], failed to show any positive effects on quality associated with practice guidelines [5,10,20,25,26,36]. Results were mixed in 12 studies, in which practice guidelines improved quality for certain outcomes or patient subgroups but not others [8,23,24,41,43,52,54,55,58,59,73,74].…”

Section: Do Practice Guidelines Improve Quality Of Care?mentioning

confidence: 99%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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“…21 Mitchell et al used education sessions to outline validated clinical pathways, with a subsequent decrease in oral reliever medications (48.4% in intervention group, 28.6% in control, p<0.001), and reduction in hospitalisation. 17 In the only study to find no impact on prescribing practice, Witt et al found that guideline based education delivered personally or via correspondence did not change prescribing rates of SABAs or ICS. 14 Some of the studies examined more multifaceted interventions.…”

Section: Impact Of Strategies To Improve Prescribingmentioning

confidence: 99%

“…Peer leader group: 6.5 fewer asthma symptom days (non -significant reduction) 17 Increase in use of ICS in group C (0.4 puffs/day compared to 0.3 puffs/day for groups A and B, p<0.05) (positive change)…”

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confidence: 99%