Asthma Care Program Improves Provider Documentation, Clinical Measures

An enhancing care for patients with asthma (ECPA) program may be an effective method for implementing evidence-based asthma quality measures as developed by the Expert Panel Report-3 guidelines according to a study published in the Journal of Asthma.

Researchers recruited 65 community centers in 4 states (Illinois, New Mexico, Oklahoma, and Texas) that serve patients with asthma and performed a pretest-posttest quasi-experimental study to evaluate the effect of a quality improvement project on 6 clinic-based performance measures: measures of asthma assessment and monitoring: documentation of asthma severity, Asthma Control Test (ACT), and pulmonary function testing; measures of education and provider/patient partnership in asthma care: asthma education and an asthma action; and a measure of medication use: controller medication prescription. These measures were collected retrospectively prior to ECPA implementation and again after the 12-month ECPA program was completed.

The 12-month ECPA program implementation consisted of the following 6 elements: an integrated health system, delivery system design promoting efficient workflow, clinical care decision support, clinical information systems supporting the use of electronic medical records, patient self-management support tools, and community resources.

At baseline, more than 75% of the centers had documentation of ACTs, pulmonary function testing, asthma education, or an asthma action plan for fewer than 50% of patients.  However, after implementation, all performance measures demonstrated statistically significant increases from both baseline to program completion (month 12) as well as from baseline to 6-month post-program completion (month 18).

ACT documentation had the highest median improvement, with an increase from 0% at baseline to 79% and 88% at months 12 and 18, respectively (adjusted rate ratio [RR] from a complete case analysis, 3.625; 95% CI, 3.125-4.124; adjusted RR from multiple imputation, 3.852; 95% CI, 3.406-4.355). In addition, 100% of patients were prescribed a controller medication at months 12 and 18 at a minimum of 50% of centers participation in the study (adjusted RR from a complete case analysis, 1.387; 95% CI, 1.254-1.534; adjusted RR from multiple imputation, 1.287; 95% CI, 1.175-1.411). Of note, there was a 25% decrease in the documentation of pulmonary function testing at month 18 compared with month 12 (adjusted RR from a complete case analysis, 0.750; 95% CI, 0.655-0.860; adjusted RR from multiple imputation, 0.768; 95% CI, 0.656-0.900).

It is important to note that there was a 100% retention rate of all 65 centers in 4 states.

The researchers concluded that not only did the implementation of Expert Panel Report-3 guidelines improve clinic-based performance measures, but the ECPA program demonstrated that its method of guideline implementation was effective in significantly improving all 6 performance measures from baseline after completion of the program. In addition, the researchers stated that the probability of centers having documented evidence for performance measures was significantly higher after completion of the program compared with the probability at baseline. 

Further, the sustainability of the program was proven to be successful because results were still significant at month 18, which was 6 months after the cessation of active researcher interventions. Clinicians should consider the implementation of the ECAP program to improve asthma management or to serve as a model for other quality improvement initiatives because it was effective in not only improving quality measures but also provider documentation.

Reference

Rojanasarot S, Nesvold JH, Karaca-Mandic P, et al. Enhancing guideline-based asthma care processes through a multi-state, multi-center quality improvement project [published online April 11, 2018]. J  Asthma. doi:10.1080/02770903.2018.1463378