Quality improvement for asthma care within a hospital-based teaching clinic

Abstract

Objective: The aim of this study was to determine if a quality improvement intervention in a teaching clinic was associated with the following: 1) improved asthma action plan creation and distribution, 2)increased classification of asthma patients as intermittent or persistent, 3) increased prescriptions of asthma controller medications, 4) decreased emergency department visits and hospitalizations, and 5) sustainable changes in outcomes after the intervention year.

Methods: A retrospective analysis was conducted of a quality improvement project involving children aged >2 years who were diagnosed with asthma, evaluated in a large hospital-based teaching clinic. Outcomes were assessed for 1 year before and 3 years after quality improvement intervention.

Results: Data from children with asthma seen in the clinic over the 4 years of the study (N = 1797) were analyzed. Mixed effects model regressions showed that children after the intervention were over twofold more likely to receive an asthma action plan (using 2006 as referent, adjusted risk ratio [ARR] 2.29, 95% confidence interval [CI] 2.03-2.56 in 2007; ARR 2.40, 95% CI 2.15-2.66 in 2008; ARR 2.86, 95% CI 2.60-3.20 in 2009). Recorded assessment of asthma severity was 31% to 47% more likely post-intervention (ARR 1.31, 95% CI 1.26-1.36 in 2007, ARR 1.44 95% CI 1.38-1.50 in 2008, ARR 1.47 95% 1.41-1.54 in 2009). Controller medication prescribing increased postintervention ARR 1.08, 95% CI, 1.02-1.14 in 2007; ARR 1.11, 95% CI, 1.04-1.17 in 2008; ARR 1.11, 95% CI, 1.05-1.19 in 2009. Emergency department visits and hospitalizations trended lower postintervention (not significant).

Conclusions: A quality improvement intervention in a hospital-based teaching clinic was associated with increased use of asthma action plans, classification of asthma severity, and controller medications, and possibly a trend toward fewer emergency visits and hospitalizations.