Reducing potentially preventable health events among patients with asthma through multi-state, multi-center quality improvement program

Abstract

Introduction

Enhancing Care for Patients with Asthma is a multi-state, multi-center quality improvement program developed to augment guideline-based practice among health care providers through Plan-Do-Study-Act cycle. This study examined the association between the implementation of the guideline-based quality improvement program and subsequent changes in asthma-related emergency room visits and hospitalizations.

Methods

This retrospective, interrupted time-series study used administrative claims data from a private insurer that provided coverage to patients receiving care from participating health centers (15 centers in New Mexico, Oklahoma, Texas, and Illinois). The 12-month implementation period started in January 2013 for centers in Cohort 1 and October 2013 for centers in Cohort 2. The claims of 1,828 patients with asthma from January 2012 to May 2015 were analyzed. The data included 12-month pre-program implementation, 12-month program implementation, and 5-month post-program completion periods.

Results

The average number of asthma-related emergency room visits and hospitalizations decreased from 2.22 to 1.38 and 1.97 to 1.04 per 100 patients per month, respectively, in the 12-month pre-implementation period as compared to 12-month implementation period. The results of three-level generalized linear mixed models found that during the 12-month implementation period, patients had 37.7% and 47.1% lower rates of emergency room visits and hospitalizations, respectively, compared to the 12-month pre-implementation period (p < 0.001 in both comparisons).

Conclusions

Enhancing Care for Patients with Asthma is an effective quality improvement program that was successfully executed in diverse geographical states and associated with reductions in potentially preventable health events. The findings support the widespread use of the program in other settings.

Keywords:

• Asthma
• disease management
• quality improvement
• pediatrics
• emergency room visits
• hospitalizations
• preventable health care utilization

Acknowledgements

The authors would like to acknowledge the American Lung Association for initiating Enhancing Care for Patients with Asthma. The authors would like to thank Health Care Service Corporation for the provision of the administrative claims data used in this study.

Conflicts of interest

This study was part of Dr. Rojanasarot's dissertation work. Dr. Rojanasarot is a full-time employee of Boston Scientific. The employment is not related to the manuscript. Dr. Karaca-Mandic provides consulting services to Precision Health Economics and Tactile Medical. These consulting activities do not have a relation to the manuscript. The other authors have no conflict of interest.