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Statewide quality improvement initiatives improve pediatric asthma
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The use of statewide quality improvement learning collaboratives can improve asthma care, with the amount of physician rated well-controlled asthma increasing from 59% to 74%, according to a study published in Pediatrics.
“Previous reports, particularly those concerning pediatric primary care, have been limited to single settings or single coordinating entities working with multiple sites with centralized quality improvement operations, thus limiting the potential for sustainability and diffusion,” Judith C. Dollins, MPH, from the American Academy of Pediatrics, and colleagues wrote. “The facilitation of statewide QI efforts would ideally result in improved care and outcomes at the population level and foster sustainable QI programs at the state level.”
To understand how to improve asthma care for children and to support QI projects using state-level expertise across varying entities in many states, the researchers used a multiwave approach in which statewide learning collaboratives were implemented through the Chapter Quality Network of the AAP. Cycles of coaching were provided by a national leadership team that instructed individual pediatric practices in two nested learning collaboratives.
Data and reporting tools were collected by state chapters. Additionally, the chapters received a curriculum that created QI learning and supported practice-level change. An asthma assessment tool and registry was used within practices, and work flows were assessed. Self-management tools were also implemented in plan-do-act cycles.
The researchers created a monthly dashboard encompassing 16 process and outcome measures, including optimal asthma care, in which the data could be gathered and analyzed using run charts. Each chapter leader gave insight as to sustainable QI change by using surveys and interviews.
Data were collected by 749 pediatricians in 180 practices in nine states for 45,431 patient encounters. Throughout the four waves of implementation, optimal asthma care increased from 42% to 81%. Well-controlled asthma also improved from 59% to 74%, a statistic rated by physicians.
“The core national leadership team and project design were critical to the success of the overall project,” Dolins and colleagues wrote. “However, the knowledge and experience gained by individual chapter leaders appeared to lead to subsequent QI projects, suggesting that the time and training invested in participating in the Chapter Quality Network could be sustained at the state level.” — by Katherine Bortz
Disclosure: The researcher provides no relevant financial disclosures.
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