Promoting Best-Care Practices in Childhood Asthma: Quality Improvement in Community Health Centers

Lob, Sibylle; Boer, Jennifer H.; Porter, Patricia G.; Núñez, David Pérez; Fox, Patrick J.

doi:10.1542/peds.2010-1962

Cited by 21 publications

(21 citation statements)

References 43 publications

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“…78 This study reported a 69% reduction in ED visits and hospitalizations. However, 44% of the patient sample was lost to follow-up, and significant heterogeneity in results was seen across participating sites.…”

Section: Multicomponentmentioning

confidence: 76%

“…75 The pre-post studies reported increases in the provision of action plans (27%-46%). [76][77][78]88 Both RCTs reported nonsignificant increases in patient education/asthma action plans (7% in 1 study; relative risk = 1.82 in the other study). 73,75 SOE: low.…”

Section: Multicomponentmentioning

confidence: 93%

“…[72][73][74][75][76][77][78] All interventions included information, education, and at least 2 of the following: organizational change, decision support, and feedback and audit. Two of the 3 pre-post studies reported 25% to 49% increases in prescribing rates.…”

Section: Multicomponentmentioning

confidence: 99%

“…Of the 6 studies we reviewed, 73,[75][76][77][78]88 most included an educational component but also included (1) training in communication techniques with provision of a spirometer and training in use of the spirometer 76 ; (2) laminated posters of guidelines and medications with feedback on asthma action plan use and monthly calls from an intervention team to troubleshoot communication problems 88 ; (3) asthma kits (peak flow meters, spacers, educational materials) and systems-level changes (flow sheets and standing medication orders) 73 ; (4) systematic use of a patient questionnaire and an asthma management algorithm 77 ; (5) an asthma coordinator and feedback on performance as part of continuous quality improvement efforts; or (6) an educational toolbox with seminars, teleconferences, mini fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. 75 The pre-post studies reported increases in the provision of action plans (27%-46%).…”

Section: Multicomponentmentioning

confidence: 99%

“…However, 44% of the patient sample was lost to follow-up, and significant heterogeneity in results was reported. 78 SOE: insufficient.…”

Section: Multicomponentmentioning

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: Multicomponentmentioning

confidence: 76%

Section: Multicomponentmentioning

confidence: 93%

Section: Multicomponentmentioning

confidence: 99%

Section: Multicomponentmentioning

confidence: 99%

“…However, 44% of the patient sample was lost to follow-up, and significant heterogeneity in results was reported. 78 SOE: insufficient.…”

Section: Multicomponentmentioning

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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What Is Left Unsaid: An Interpretive Description of the Information Needs of Parents of Children With Asthma

Archibald

Caine

Ali

et al. 2015

Research in Nursing & Health

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Parents of children with asthma provide the vast majority of day-to-day asthma care. Understanding their information needs is an essential step to provide meaningful and effective family-centered asthma education. To gain insight into the information needs and information deficits of parents of children with asthma, we conducted an interpretive descriptive study to capture the perspectives of 21 parents from diverse backgrounds whose 23 children with asthma had a range of illness trajectories and management scenarios. Parents were purposively sampled from two asthma clinics and one pediatric emergency department in a large urban center in North America. Semi-structured interviews were conducted in 2011-2012. In data analysis, parents' self-identified information needs were distinguished from analysts' interpretations of information deficits. Participants' knowledge did not always reflect time since diagnosis, and information needs and deficits persisted for years. Parents often reported receiving little or no little or no education about asthma and its management. An asthma management information hierarchy was identified, starting with the most foundational, recognizing severity; followed by acute management; prevention versus crisis orientation; and knowing "about" asthma. In the absence of adequate and accurate education, parents' beliefs about the nature of asthma as an acute rather than chronic condition shaped their asthma management decisions and information-seeking behaviors. Information deficits were affected by interactions with health care providers. These parents' pervasive unmet information needs and deficits highlight the need for comprehensive, problem-oriented asthma education.

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Community-Based Interventions in Asthma

Croisant

Scott

2013

Heterogeneity in Asthma

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Community and public health interventions provide potentially powerful means of decreasing morbidity, hospitalizations, emergency room visits, and mortality from asthma. This chapter thus provides an overview of community-based interventions, which have been demonstrated to be effective-and/or ineffective-in reducing the burden of disease, including development of asthma coalitions, interventions for both provider and patient education, environmental controls to reduce exposure to asthma triggers, and institutional policy and systems change. Perhaps most important is the demonstrated effect of integrated, comprehensive approaches to asthma management and control. A multidisciplinary approach spanning T1 through T4 translational research, coupled with public health activities is promising and has already demonstrated success in reducing the burden of disease.

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Promoting Best-Care Practices in Childhood Asthma: Quality Improvement in Community Health Centers

Abstract: On a larger scale, this approach realized impressive changes in provider clinical practice associated with major improvements in health outcomes. It holds great potential for significantly reducing asthma-related morbidity among low-income children.

Cited by 21 publications

References 43 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

What Is Left Unsaid: An Interpretive Description of the Information Needs of Parents of Children With Asthma

Community-Based Interventions in Asthma

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