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Spring-Summer, 2012

GIP in Focus

What a Difference a Year Makes!

Changes Lead to More Than Twice as Many Patients with Asthma Receiving Optimal Care in 49 Pediatric Practices

The National Asthma Education and Prevention Program’s (NAEPP) clinical practice guidelines provide a road map for quality asthma care. To improve asthma outcomes, increasing adherence to the guidelines’ evidence-based recommendations is a must.

That’s why the NAEPP gleaned from these guidelines six key actions that health care providers, patients, families and caregivers of patients, and other asthma stakeholders can take together to improve asthma care and control.

To increase the number of pediatric practices taking the six actions and following the NAEPP guidelines, the American Academy of Pediatrics (AAP) launched a yearlong study to see whether a quality improvements program that incorporates these messages would make a difference.

Map of doctor, mother and daughter looking at an Asthma Action Plan

Four AAP chapters—in Alabama, Maine, Ohio, and Oregon—sought 12 to 13 practices in each state to volunteer for training on quality improvement (QI) that included post-training sharing of data, best practices, and other information.

“The key is to find a system where health care providers are readily reminded how to care for a patient who has asthma,” said Paul V. Williams, M.D., a pediatric allergist. “As in the case of the AAP study, developing a QI project where practices are forced to change their behavior, and giving them time to change their behavior, is one method that could work.”

Dr. Williams was not part of the study; however, he did provide expert commentary on it based on 20 years on the NAEPP Coordinating Committee and its Schools Asthma Subcommittee, and firsthand experience as a practicing allergist who sees 20 to 25 children with asthma each week.

The study kicked off with a training of the state chapters by the AAP national office. Those chapters then recruited and trained three-person teams from practices that had stepped forward to participate. After completing the training, the mini-teams went back to their practices and began to implement QI projects, which included creating workflow diagrams to map what happens to patients who have asthma at every step of an office visit.

Many practices created a formal registry to collect and keep information about patients—using AAP’s online system to track and evaluate the data—and instituted a guidelines-based stepwise treatment approach which, among other things, includes individualized asthma action plans (the NAEPP’s focus for Asthma Awareness Month and World Asthma Day 2012).

“It really makes you think about what you are doing, set up systems, and incorporate them into your practice,” said Williams.

But that was not the only step that the QI project took: Throughout the process, AAP officials communicated regularly (via monthly conference calls, webinars, Web-based knowledge sharing, and a QI coach) to help address problems and answer questions.

These efforts led to a resounding success. In participating practices, patients receiving “optimal care”—defined as the use of a validated form to assess asthma control, the stepwise treatment approach, development of a patient asthma action plan, and provision of a flu shot—jumped from 35 to 85 percent in a mere year. That means more than twice as many children with asthma were receiving better asthma care.

And there was better asthma control, too. Researchers found that the number of patients with well-controlled asthma at participating practices rose from 58 to 72 percent.

“The important thing about the AAP study is to make sure that it is sustainable,” said Williams, “And to test that it should be rolled out to other AAP chapters and practices.”

To learn more about the study, visit “National Academy and Affiliated State Chapters Support Pediatricians in Improving Asthma Care, Leading to Better Guideline Adherence and Disease Control, Fewer Acute Episodes.”

Last Updated June 2012

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