Improving Asthma Care Through Recertification<subtitle>A Cluster Randomized Trial</subtitle>

Abstract

Background: As part of recertification, the American Board of Internal Medicine requires its diplomats to complete at least 1 practice improvement module (PIM). We assessed whether completing an asthma-specific PIM resulted in improved patient outcomes. Methods: Practices were the unit of randomization in this cluster randomized trial. Physicians in the intervention group were asked to complete the PIM through its planning phase. The primary outcome was the dispensing of an inhaled corticosteroid (ICS) after a postintervention visit for asthma. Secondary outcomes included patient reported processes of care, asthma-related heath care use, and asthma severity. Analyses were adjusted for baseline rates at the cluster-level as well as for individual sociodemographic characteristics. Results: Eight practices (19 internists) were randomized to the intervention group and 8 practices (21 internists) to the control group. For the primary outcome, ICS fill rates, patients seen by intervention group physicians were not more likely to fill an ICS prescription in the post-intervention period than patients seen by control group physicians (adjusted odd ratio [AOR], 1.00; 95% confidence interval [CI], 0.64-1.56). Patients seen for asthma by intervention group physicians were less likely to receive a written action plan than patients seen by control group physicians (AOR, 0.67; 95% CI, 0.48-0.93); however, they were more likely to discuss potential asthma triggers (AOR, 1.62; 95% CI, 1.08-2.42) and had lower self-reported asthma severity measures (unadjusted P=.03). Per-protocol analysis supported the latter 2 associations. Conclusion: A PIM designed to improve asthma care did not improve filling of ICS prescriptions but may have lessened asthma severity through an increased discussion of asthma triggers.

Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence Among Adults with Asthma

“…The last criterion was included to ensure that the patient was supposed to be on continuous ICS therapy, an implicit assumption in claims-based measures of adherence. We have also previously shown that a clinical diagnosis of asthma in our data systems is highly predictive of patient-reported asthma (15). We excluded patients whose last ICS prescription was explicitly stopped by their physician.…”

Maintenance of Certification Part IV Quality-Improvement Project for Hypertension Control: A Preliminary Retrospective Analysis

“…Combined with an overall improvement in hypertension control, the results would indicate that participation in MOC within a QI setting does not have a negative effect on physician participants. [14][15][16] Although overall improvement was observed in this cohort, KPNC overall also showed improvement during that same timeframe, from 81% in mid-2011 to 86.7% at the end of 2013. It is probable that the observed increase in the MOC cohort may have been mirroring that of the entire area, especially since this project was based on previously implemented strategies.…”

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

“…32,33 Similarly, performance feedback on specific practices has been extensively used in health maintenance organizations for quality improvement, 34–38 however, this is not standard practice in health care settings, and information rarely is relayed at the time of a patient visit. Multifaceted interventions, such as PAIR-UP, appear to yield the greatest success in improving asthma care.…”