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Quality improvement strategies for children with asthma: a systematic review
Dena M Bravata1, Allison L Gienger, Jon-Erik C Holty
1Center for Primary Care and Outcomes Research, Stanford, CA 94305-6019, USA. dbravata@stanford.edu
Insights
Quality improvement strategies significantly enhance pediatric asthma care. Self-management interventions reduced symptom days and school absences, while provider education and organizational changes improved medication adherence.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Evidence-Based Medicine
Background:
- Asthma is a prevalent chronic respiratory condition in children, necessitating effective outpatient management strategies.
- Quality improvement (QI) initiatives aim to optimize healthcare processes and patient outcomes.
Purpose of the Study:
- To systematically review the evidence on the effectiveness of QI strategies in improving outpatient pediatric asthma care processes and outcomes.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Cochrane, MEDLINE) for English-language studies published up to April 2006.
- Included study designs were randomized controlled trials, controlled before-after trials, and interrupted time series evaluating QI interventions in pediatric asthma.
- Key outcome measures included clinical status, functional status (e.g., school absenteeism), and healthcare utilization (e.g., hospital admissions).
Main Results:
- Seventy-nine studies met the inclusion criteria, with the majority focusing on patient education, self-monitoring, or self-management.
- Self-management interventions led to a significant increase in symptom-free days (approx. 10 days/year) and a reduction in school absenteeism.
- Provider education and organizational changes were associated with improved medication use; interventions with multiple educational sessions and longer durations showed greater patient benefits.
Conclusions:
- Various QI interventions demonstrably improve both processes and outcomes in pediatric asthma care.
- Standardizing outcome measures and providing detailed intervention descriptions are crucial for advancing future QI research in this field.
Objective:
To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care.
Data Sources:
Cochrane Effective Practice and Organisation of Care Group database (January 1966 to April 2006), MEDLINE (January 1966 to April 2006), Cochrane Consumers and Communication Group database (January 1966 to May 2006), and bibliographies of retrieved articles.
Study Selection:
Randomized controlled trials, controlled before-after trials, or interrupted time series trials of English-language QI evaluations.
Interventions:
Must have included 1 or more QI strategies for the outpatient management of children with asthma.
Main Outcome Measures:
Clinical status (eg, spirometric measures); functional status (eg, days lost from school); and health services use (eg, hospital admissions).
Results:
Seventy-nine studies met inclusion criteria: 69 included at least some component of patient education, self-monitoring, or self-management; 13 included some component of organizational change; and 7 included provider education. Self-management interventions increased symptom-free days by approximately 10 days/y (P = .02) and reduced school absenteeism by about 0.1 day/mo (P = .03). Interventions of provider education and those that incorporated organizational changes were likely to report improvements in medication use. Quality improvement interventions that provided multiple educational sessions, had longer durations, and used combinations of instructional modalities were more likely to result in improvements for patients than interventions lacking these characteristics.
Conclusions:
A variety of QI interventions improve the outcomes and processes of care for children with asthma. Use of similar outcome measures and thorough descriptions of interventions would advance the study of QI for pediatric asthma care.
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