Case analyses of state-sponsored asthma quality improvement interventions - benefits and technical assistance efforts

A cross-case analysis was used to discover how two states benefited from expanded use of evaluation for asthma quality improvement initiatives. If an asthma quality improvement (QI) initiative is successfully evaluated, data can inform how to effectively integrate clinical practice guidelines and circumvent non-clinical reasons that interrupt QI projects such as low staff interest. This article addresses a gap in the literature on quality of evaluation support needed to improve and sustain asthma QI at local health care organizations by describing the similar discoveries observed at two independent QI statewide initiatives in Indiana and Montana.

As part of a larger review, two states funded through the National Asthma Control Program at the Centers for Disease Control and Prevention were identified based on similarities in evaluation approaches. Each state used an iterative stakeholder-driven evaluation approach, mixed methods, process evaluation indicators, and active use of evaluation findings. The asthma QI initiatives and evaluations in Indiana and Montana were coordinated independent of each other.

Although both states found that asthma QI initiatives improved health outcomes, evaluation data were able to further pinpoint areas that would improve quality of technical support to health care organizations and identify markers of sustainability, such as nontraditional benefits to staff, and intervention sites.

Findings suggest that when evaluation is used to guide implementation, data are available to develop site-specific assistance and identify sustainability markers to prevent interruption of positive health outcomes associated with an asthma QI initiative.