QUALITY IMPROVEMENT TECHNIQUE IMPROVES MANAGEMENT OF ASTHMA IN OFFICE-BASED PRACTICES CJ Homer, SA Finch, P Heinrich, S Salem-Schatz, EJ Slora, RC Wasserman. National Initiative for Children's Healthcare Quality, Inst for Healthcare Improvement, Boston, MA; and Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL. Presented as a poster symposium presentation at the 2000 Pediatric Academic Societies? Annual Meeting.

BACKGROUND: Although national guidelines exist for the diagnosis and management of asthma, practice varies substantially from recommendations. Interventions based on traditional clinician education have resulted in few changes in management.

OBJECTIVE: To determine if the quality of office-based care for children with asthma improved when using an action oriented learning model that applies quality improvement methods modified for the primary care setting.

DESIGN/METHODS: Twenty geographically dispersed practices recruited from a national practice-based research network participated in an uncontrolled 9 month intervention study. The intervention consisted of (1) formal instruction of practice teams (pediatrician and nurse) in two workshops (baseline and five months later) in asthma management and implementation of rapid cycle change quality improvement, (2) a tool kit of asthma protocols, teaching materials, and quality improvement aids, and (3) biweekly conference calls led by quality improvement experts in which participating pediatricians and nurses shared and discussed their asthma care plans and experiences. Practices made changes in asthma care according to their own needs and using feedback from conference calls. Data were collected from patients/parents, pediatricians, and through chart reviews for 10 consecutive asthma patients in each practice in 3 cycles: immediately before workshop 1, before workshop 2, and 2 months after workshop 2. Outcomes were changes in performance of key components of asthma care, including appropriate medication use, from baseline to the third assessment, as well as changes in the agreement between the three sources of information.

RESULTS: Discussion of nighttime symptoms, activity limits, and management plans increased by more than 20%. Documentation of severity classification in the chart increased by 50%. Management plans in the chart increased by 32%, and plans given to the patient/parent increased by 28%. Improvement in agreement was seen in all key areas from the baseline to final data collection. All listed differences were significant at p<.0001.

CONCLUSION: Pediatric practices improved their management of patients with asthma while using quality improvement techniques. Controlled trials should assess the effectiveness of this approach in changing practice and health status outcomes.