Colorado Asthma Toolkit Implementation Improves Some Process Measures of Asthma Care

J Am Board Fam Med. 2019 Jan-Feb;32(1):37-49. doi: 10.3122/jabfm.2019.01.180155.


Background: The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes.

Objective: To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care practices.

Methods: This is an implementation study involving secondary prepost analysis of existing structured clinical, administrative, and claims data. Nine primary care practices in a federally qualified health center network implemented the CATP. Processes of care and health and utilization outcomes were evaluated prepost implementation in a cohort of patients with asthma using generalized linear mixed models.

Results: The study cohort included 2678 patients age 5 to 64 years with at least one visit to one of the 9 participating practices during the study period (March 12, 2010 to December 1, 2012). A comparison of 12 months pre- and post-CATP implementation showed improvement in some process measures of asthma care associated with the intervention, including the rate of asthma-severity measurement, although no change in 2 Health care Effectiveness Data and Information Set measures: asthma medication ratio and medication management for people with asthma. We also found no change in asthma outcomes measured across multiple domains: exacerbations, utilization, symptom scores, and pulmonary physiology measures.

Conclusions: Implementation of the CATP in a primary care setting led to some improved processes of asthma care, but no changes in measured outcomes. Recommendations for future work include supplemental follow-up training including case review.

Keywords: Asthma; Colorado; Outcomes Assessment; Primary Health Care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Asthma / diagnosis
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Colorado
  • Datasets as Topic
  • Disease Progression
  • Female
  • Health Plan Implementation / organization & administration*
  • Health Plan Implementation / statistics & numerical data
  • Humans
  • Implementation Science
  • Male
  • Middle Aged
  • Primary Health Care / organization & administration*
  • Primary Health Care / statistics & numerical data
  • Process Assessment, Health Care / statistics & numerical data*
  • Program Evaluation
  • Quality Improvement*
  • Quality of Life
  • Safety-net Providers / organization & administration
  • Safety-net Providers / statistics & numerical data
  • Severity of Illness Index
  • Young Adult