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Practice-level effects of interventions to improve asthma care in primary care settings: the Pediatric Asthma Care Patient Outcomes Research Team.
- Source :
-
Health services research [Health Serv Res] 2005 Dec; Vol. 40 (6 Pt 1), pp. 1737-57. - Publication Year :
- 2005
-
Abstract
- Objective: To assess the practice-level effects of (1) a physician peer leader intervention and (2) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement. And, to compare findings with previously reported patient-level outcomes of trial enrollees.<br />Study Setting: Data were included on children 5-17 years old with asthma in 40 primary care practices, affiliated with managed health care plans enrolled in the Pediatric Asthma Care Patient Outcomes Research Team (PORT) randomized trial.<br />Study Design: Primary care practices were randomly assigned to one of two care improvement arms or to usual care. Automated claims data were analyzed for 12-month periods using a repeated cross-sectional design. The primary outcome was evidence of at least one controller medication dispensed among patients with persistent asthma. Secondary outcomes included controller dispensing among all identified asthmatics, evidence of chronic controller use, and the dispensing of oral steroids. Health service utilization outcomes included numbers of ambulatory visits and hospital-based events.<br />Principal Findings: The proportion of children with persistent asthma prescribed controllers increased in all study arms. No effect of the interventions on the proportion receiving controllers was detected (peer leader intervention effect 0.01, 95 percent confidence interval [CI]: -0.07, 0.08; planned care intervention effect -0.03, 95 percent CI: -0.09, 0.02). A statistical trend was seen toward an increased number of oral corticosteroid bursts dispensed in intervention practices. Significant adjusted increases in ambulatory visits of 0.08-0.10 visits per child per year were seen in the first intervention year, but only a statistical trend in these outcomes persisted into the second year of follow-up. No differences in hospital-based events were detected.<br />Conclusions: This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions, using automated data. The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self-reported data from trial enrollees. Analysis of automated data on nonenrollees adds information about practice-level impact of care improvement strategies. Benefits of practice-level interventions may accrue disproportionately to the subgroup of trial enrollees. The effect of such interventions may be less apparent at the level of practices or health plans.
- Subjects :
- Adolescent
Adrenal Cortex Hormones therapeutic use
Child
Child, Preschool
Cross-Sectional Studies
Drug Utilization
Female
Health Services statistics & numerical data
Humans
Male
Office Visits statistics & numerical data
Peer Group
Anti-Asthmatic Agents therapeutic use
Asthma therapy
Outcome Assessment, Health Care
Practice Patterns, Physicians' standards
Primary Health Care standards
Subjects
Details
- Language :
- English
- ISSN :
- 0017-9124
- Volume :
- 40
- Issue :
- 6 Pt 1
- Database :
- MEDLINE
- Journal :
- Health services research
- Publication Type :
- Academic Journal
- Accession number :
- 16336546
- Full Text :
- https://doi.org/10.1111/j.1475-6773.2005.00451.x