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

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords:

• Asthma
• clinical guidelines
• quality improvement
• evaluation
• program improvement
• technical assistance

Acknowledgment

We thank Jessie Fernandes (Montana Asthma Control Program), IDOH Office of Primary Care, and Maureen Wilce (CDC Asthma and Community Health Branch) for their scientific consultation and technical assistance in the development of evaluation, case analyses, and article.

Declaration of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Notes

1 Asthma action plan should have instruction on the appropriate medications for patient to use, how to recognize escalating symptoms, and recommended strategies for asthma-related emergencies.

2 Using evaluation to improve evaluation was a third theme identified for both states. This theme is not discussed in this article.

3 Other requests were beyond IAP’s scope and included requests for spacers and other direct patient care supplies.

4 https://dphhs.mt.gov/publichealth/brfss

5 https://dphhs.mt.gov/publichealth/brfss

6 Most hospitals in Montana are designated critical access hospitals. Often, they are the only emergency medical facility for hundreds of miles, providing primary care and emergency care.

7 A comprehensive description of these health outcome data are reported in Sirikan, Heins, Nesvold, Pinar, et al (2019) report on “Enhancing guidelines-based asthma care processes through a multi-state, multi-center quality improvement program.” Journal of Asthma, 56(4), 440-450.