Appendix C. Examples of Asthma HDC System Improvements
Asthma Health Disparities Collaborative Coalition Guide
This appendix lists improvements that have been noted in the scientific and resource literature of the type of improvements Asthma Collaboratives might expect.
Health Disparities Collaboratives (HDC) national data from 2002 report the following: Proper use of inhaled anti-inflammatory medication improved from 30% to 80%, and the percentage of patients who reported symptom-free days improved from 30% to 76%.
Source: Health Disparities Collaboratives. HDC Topics: Asthma. Available at: http://www.healthdisparities.net/hdc/html/collaboratives.topics.asthma.aspx. Accessed March 5, 2007.
Schonalau and colleagues conducted a pre-post evaluation of 185 patients in six intervention clinics (Asthma HDC) and three control clinics. The intervention included a 2-day educational session for clinic teams followed by three PDSA action periods over the course of a year. Study results were reported in 2005 indicating that patients in the intervention group were more likely than patients in the control group to:
- Monitor their peak flow (57% vs. 24%).
- Have a written action plan (43% vs. 27%).
- Be satisfied with provider communication (62% vs. 39%).
Source: Schonlau M, Smith RM, Chan KS, et. al. Evaluation of a quality improvement collaborative in asthma care: does it improve processes and outcomes of care? Ann Fam Med 2005;3(3):200-8.
Kaiser Permanente, Northern California (KP-NC) serves 3 million people in the northern California region. Using the Chronic Care Model, including chronic care management, KP-NC saw a drop in the emergency department visit rate for asthma from 10 per 1000 persistent patients with asthma in 1996 to 4 per 100 in 2000.
Source: Bodenheimer T, Wager EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288(14):1775-79.
With support from the Robert Wood Johnson Foundation, RAND/UC-Berkeley evaluated the organizational and patient-level impact of participation in the Asthma HDC for children and adolescents in nine geographically dispersed health centers. Results showed significantly increased scores on the general health quality of life (0 to 100-point) scale. Failure to receive appropriate asthma medications according to the child's level of disease severity decreased general health-related quality of life by 6.16 points. Inappropriate treatment of asthma also significantly decreased asthma-specific health related quality of life by 9.8 points.
In February 2000, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation National Program, "Improving Chronic Illness Care" (ICIC) began a 13-month collaborative that focused on asthma and depression. Of the participating community health centers, 23 selected asthma as their area of focus. The five most common measures tracked by the asthma teams included:
- Symptom-free days.
- Urgent care and/or emergency room visits.
- Use of written asthma/self-management plan.
- Use of maintenance anti-inflammatory medications.
- School/work absences.
Participating teams reported the following results:
- In 22 centers, the percentage of patients with persistent asthma who were treated with maintenance anti-inflammatory medications increased from 10% to 70%.
- In 1 center, the percentage of patients on the registry with an asthma action plan on medical chart rose from 0% to 100%.
- In school-based centers, the average number of school days missed in the last 3 months declined from 0.9 day to 0.1 day.
Source: Institute for Healthcare Improvement. Breakthrough Series Collaborative on Improving Care for People with Chronic Conditions: February 2000-February 2001. Summary Report on Asthma Teams. Available at: http://www.healthdisparities.net. Accessed Jan. 31, 2007