Quality Improvement Strategies for Children With Asthma

Bravata, Dena M; Gienger, Allison; Holty, Jon Erik C.; Sundaram, Vandana; Khazeni, Nayer; Wise, Paul H.; McDonald, Kathryn M; Owens, Douglas K

doi:10.1001/archpediatrics.2009.63

Cited by 70 publications

(58 citation statements)

References 90 publications

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“…30 Bratava and colleagues showed in a meta-analysis that self management programs favour quality improvement in general -but there were multiple strategies used in the different studies. 31 Our findings -that asthma management provided by a hospital-based specialised asthma nurse is not inferior to management provided by a GP or a paediatrician -agrees with the earlier findings of Kamps et al 16 This may have important implications for the organisation of paediatric outpatient care. First, nurse-led outpatient management can be provided at a lower cost than medical care by a paediatrician.…”

Section: Discussionsupporting

confidence: 90%

“…We showed in an earlier paper 29 a small but statistically significant difference in ACQ between children treated in primary care and in hospital care, whereas all the other measured parameters showed no statistically significant difference. Publications by Kelly et al 30 and Bratava et al 31 slightly favour specialist care over primary care. However, the populations and health care settings in these studies differ considerably from the Dutch situation.…”

Section: Discussionmentioning

confidence: 97%

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Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up

Kuethe

Vaessen-Verberne

Mulder

et al. 2011

Primary Care Respiratory Journal

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Aims: For children with stable asthma, to test non-inferiority of care provided by a hospital-based specialised asthma nurse versus a general practitioner (GP) or paediatrician.Methods: Randomised controlled trial evaluating standard care by a GP, paediatrician or an asthma nurse, with two-year follow-up.Results: 107 children were recruited, 45 from general practice and 62 from hospital. After two years, no significant differences between groups were found for airway responsiveness, FEV1, asthma control, medication, school absence or parental work absence. In the general practice group there was a significantly lower frequency of regular review visits ('regular' = at least one review per six months) compared to the paediatrician and specialised asthma nurse group, both after one year [45.7% versus 87.9% and 94.3%, respectively, (p<0.0005)] and after two years [26.5% versus 87.9% and 75.8%, respectively, (p<0.0005)]. We found no significant differences in unplanned visits. In most cases the asthma nurse was able to provide care without consultation with the paediatrician. Conclusion:The degree of disease control in stable childhood asthma managed by an asthma nurse is not inferior to traditional management by primary or secondary care physicians. The results also suggest that a lower review frequency does not detract from good disease control.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up

Kuethe

Vaessen-Verberne

Mulder

et al. 2011

Primary Care Respiratory Journal

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“…Practices should consider using allied health professionals to demonstrate or assess device technique with children with asthma when their providers do not have time to do so. [20][21][22][23][24] In addition to providers showing patients how to correctly use asthma devices, patients and their families could be encouraged to ask their community pharmacists about proper use of these devices. 8 Pharmacists can be a valuable resource for patients in providing counseling and education regarding inhaler use.…”

Section: Discussionmentioning

confidence: 99%

Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits

Sleath

Ayala

Gillette³

et al. 2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Little is known about the extent to which providers model proper use of asthma devices to children or the extent to which providers have the children demonstrate how they use their devices during medical visits. WHAT THIS STUDY ADDS:The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.abstract OBJECTIVE: The purposes of this study were to (a) describe the extent to which children use metered dose inhalers, turbuhalers, diskuses, and peak flow meters correctly, and (b) investigate how often providers assess and demonstrate use of metered dose inhalers, turbuinhalers, diskuses, and peak flow meters during pediatric asthma visits. PATIENTS AND METHODS:Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All of the medical visits were audiotape-recorded. Children were interviewed after their medical visits, and their device technique was observed and rated by the research assistants. RESULTS:Of the patients, 296 had useable audiotape data. Only 8.1% of children performed all of the metered dose inhaler steps correctly. Older children were more likely to get more of the metered dose inhaler steps correct. Of the children, 22% performed all of the diskus steps correctly, 15.6% performed all of the turbuhaler steps correctly, and 24% performed all of the peak flow meter steps correctly. The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.

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“…A recent systematic review of 79 quality improvement interventions for children with asthma found that several types of interventions improved process and outcomes of care, although the magnitude of improvement was often modest. 41 Of the 6 studies that exclusively enrolled adolescent patients, none showed significant improvement in key asthma outcomes, such as medication use, asthma symptom control, or use of health services. In addition, these studies often did not quantitate the process improvements that were associated with improvement in outcomes.…”

mentioning

confidence: 99%

Improving Outcomes for Underserved Adolescents With Asthma

et al. 2014

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BACKGROUND AND OBJECTIVE: Asthma is the most common chronic disease of childhood. Treatment adherence by adolescents is often poor, and their outcomes are worse than those of younger patients. We conducted a quality improvement initiative to improve asthma control and outcomes for high-risk adolescents treated in a primary care setting. METHODS:Interventions were guided by the Chronic Care Model and focused on standardized and evidence-based care, care coordination and active outreach, self-management support, and community connections. RESULTS:Patients with optimally well-controlled asthma increased from ∼10% to 30%. Patients receiving the evidence-based care bundle (condition/severity characterized in chart and, for patients with persistent asthma, an action plan and controller medications at the most recent visit) increased from 38% to at or near 100%. Patients receiving the required self-management bundle (patient selfassessment, stage-of-readiness tool, and personal action plan) increased from 0% to ∼90%. Patients and parents who were confident in their ability to manage their or their adolescent' s asthma increased from 70% to ∼85%. Patient satisfaction and the mean proportion of patients with asthma-related emergency department visits or hospitalizations remained stable at desirable levels.CONCLUSIONS: Implementing interventions focused on standardized and evidence-based care, self-management support, care coordination and active outreach, linkage to community resources, and enhanced followup for patients with chronically not-well-controlled asthma resulted in sustained improvement in asthma control in adolescent patients. Additional interventions are likely needed for patients with chronically poor asthma control. Pediatrics 2014;133:e418-e427 Drs Britto and Byczkowski conceptualized and designed the project, contributed to the acquisition of the data and analysis and interpretation of the results, and drafted the initial manuscript; Ms Vockell, Ms Munafo, Ms Wimberg, and Mr Pruett contributed to the conception and design the project, the acquisition of the data, and analysis and interpretation of the results; Ms Schoettker contributed to the analysis and interpretation of the results and drafted the initial manuscript; Dr Yi contributed to the conception and design of the project and helped to draft the initial manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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Quality Improvement Strategies for Children With Asthma

Abstract: To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care.

Cited by 70 publications

References 90 publications

Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up

Paediatric asthma outpatient care by asthma nurse, paediatrician or general practitioner: randomised controlled trial with two-year follow-up

Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits

Improving Outcomes for Underserved Adolescents With Asthma

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