Improving pediatric asthma care: A partnership between pediatric primary care clinics and a free-standing Children's Hospital

Abstract

Background: Asthma is a common chronic disease of childhood. Providers’ adherence to asthma guidelines is still less than optimal. Objectives: To determine if an Asthma Education Program aimed at primary care practices can improve asthma care within practices and if the results vary by duration of the program. Methods: Ten practices were randomly assigned to an Early Asthma Education Intervention (EI) group or a Delayed Asthma Education Intervention (DI) group. The EI group received the intervention for 12 months and was monitored for 6 additional months. The DI group was observed without intervention for 12 months, then received the intervention for 6 months, and was monitored for 6 additional months. The program included training of asthma educators in each practice and then monitoring for improvement in medical record documentation of National Asthma Education and Prevention Program (NAEPP) asthma quality indicators by blinded random review of patient charts. Results: In the EI group, 6-, 12-, and 18-month data revealed significant improvement in documentation of asthma severity, education, action plan, night time symptoms, and symptoms with exercise compared to baseline and compared to DI group at baseline and at the 12-month interval. In the DI group, significant improvement in documentation in all of the above endpoints and also in documentation of NAEPP treatment guidelines was noted at 18 and 24 months. In both groups, documentation levels remained relatively stable at 6 months after the intervention, with no significant differences between groups. While improved, guideline adherence was <80% for half of the indicators. Conclusion: In-office training of non-physician asthma providers improves the quality of asthma care.

Keywords:

• Asthma
• children
• primary care
• education

Acknowledgement

We acknowledge all of the pediatric practices, asthma team leaders and staff who have participated in the Train the Trainer program.

Declaration of interest

The authors report no conflicts of interests and have no relevant disclosures. The study sponsors had no role in study design; data collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the paper for publication. Include statements even when the sponsor had no involvement in the above matters. This study was funded by unrestricted grants by Children's Hospital, Inc., Children's Research Institute, Columbus Medical Association, Merck Pharmaceuticals, GlaxoSmithKline Fund, AstraZeneca, American Lung Association (Columbus chapter), Columbus Foundation. No potential conflict of interest exist with any companies or organizations whose products and services may be discussed in this article. The authors have no financial relationships relevant to this article to disclose.