Variation in managing asthma: experience at the medical group level in California

To explore the degree of variation in the quality of asthma management among physician groups participating in a managed care network.

Cross-sectional observation.

The study population consisted of patients with moderate or severe asthma identified through a pharmacy database from a managed care plan in 1996. The patients were surveyed to obtain their assessments of asthma care, including components on quality of care, quality of service, and outcomes of care. We selected 47 physician groups that provided services for at least 35 asthma patients who responded to the survey. Variations in the outcome variables across physician groups were described by quartile, range, and histogram.

Compliance with national guidelines varied among physician groups but was generally low. Physician group rates for patient use of steroid inhalers ranged from 10.7% to 45.5% and daily peak flow meter use ranged from 0% to 13.1%. Satisfaction ratings were higher, with overall satisfaction with the quality of asthma care ranging from 74.6% to 94.3%. Outcomes also showed considerable variation among groups. One-month absenteeism rates ranged from 32% to 61%, and 65.7% to 94.3% of respondents did not have an emergency room visit in the past year.

The quality of asthma care and service varied significantly across physician groups. Such reports for different physician groups make evidence-based outcomes information directly available to patients and physician groups, help patients make informed healthcare decisions, and stimulate quality improvement efforts by physician groups.