Outcomes/Effectiveness Research

Interventions that improve asthma outcomes in clinical trials may not translate to the practice level

Practice-based physician peer leader education and an asthma nurse educator improved use of asthma controller medications and reduced hospital and emergency department (ED) visits among children with asthma enrolled in a randomized trial. When measured on all patients in the participating practices using automated claims data, these same asthma care improvement interventions resulted in a slight increase in outpatient asthma visits, but no detectable impact on asthma medication use or asthma-related hospital and ED visits.

While these results do not negate the effect of direct contact with the nurse educator in clinical practices, they suggest that there was no spill-over effect on asthma care in the practices as a whole, either from the nurse or the peer leader. Researchers randomly assigned 40 primary care practices participating in the Pediatric Asthma Care Patient Outcomes Research Team trial, which is supported by the Agency for Healthcare Research and Quality (HS08368), to one of the two care improvement arms or to usual care.

The proportion of children with persistent asthma who were prescribed controllers increased in all three groups over the study period. No effect of the interventions on the proportion of all asthmatic children receiving controllers was detected. Small increases in outpatient visits of 0.08-0.10 visits per child per year were seen in practices in the first intervention year, but not the second year. No group differences in hospital-based events were detected. The authors call for more work to refine the types of intervention strategies that will help practices and health plans realize the benefits of adopting practice guidelines and innovative models for chronic and preventive care.

See "Practice-level effects of interventions to improve asthma care in primary care settings: The pediatric asthma care patient outcomes research team," by Jonathan A. Finkelstein, M.D., M.P.H., Paula Lozano, M.D., M.P.H., Anne L. Fuhlbrigge, M.D., M.S., and others, in the December 2005 HSR: Health Services Research 40(6), pp. 1737-1757.

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