Asthma Health Outcomes Achieved through a Clinic-based Quality Improvement Program

Abstract

Asthma is a chronic condition that is prevalent in both children and adults. However, despite numerous and costly national quality improvement efforts, persons with asthma continue to receive suboptimal care. This is due in part to providers’ non-adherence to asthma guidelines, which impedes achievement of asthma treatment goals, resulting in unnecessary use of health care resources. Thus, evidence-based quality improvement programs that enhance the quality of care would be beneficial to both providers and patients. The primary aim of my dissertation was to address research and practice gaps that exist in quality improvement research by establishing evidence for a community-based asthma care improvement program implemented in 65 clinic sites across four states. The aim of this program was to improve asthma care among providers in real-world practice. This dissertation focused on three outcomes: 1) six clinic-based, guideline-recommended performance measures of asthma care; 2) preventable health events due to asthma; and 3) total asthma-related health care costs. The results of this dissertation are presented as three publishable manuscripts. The first manuscript addresses the effect of the program on clinic-based performance measures. It was found that, compared with performance prior to program implementation, the rates of documenting the six guideline-based performance measures increased significantly and remained improved following program completion. The second manuscript examines the program’s effect on asthma-related emergency room visits and hospitalizations. The results showed that the rates of these two events decreased by 42.1% and 50.0%, respectively, during the 12-month implementation and 5-month post-program completion periods. Using patient-level administrative claims data in multilevel generalized linear modeling, the results from the third manuscript found that implementation was associated with a 56.4% reduction in total asthma-related health care costs, while post-program completion was associated with a 57.3% reduction. This dissertation contributes significantly to both clinical and policy perspectives on quality improvement research. First, this work provides evidence for the enhancement of both provider- and patient-focused asthma-related outcomes through standardized quality improvement efforts at the clinic level in diverse geographic areas and across multiple clinic sites. Further, this dissertation provides an analytical framework for the evaluation of real-world health care interventions that have been missing in quality improvement research. Policy researchers could apply the analytic framework documented in this dissertation in the evaluation of health outcomes of complex quality improvement programs, not only for patients with asthma, but also those with other chronic conditions.