Impact of a quality improvement program on care and outcomes for children with asthma

Objective: To test a quality improvement intervention, a learning collaborative based on the Institute for Healthcare Improvement's Breakthrough Series methodology, specifically intended to improve care and outcomes for patients with childhood asthma. Design: Randomized trial in primary care practices. Setting: Practices in greater Boston, Mass, and greater Detroit, Mich. Participants: Forty-three practices, with 13 878 pediatric patients with asthma, randomized to intervention and control groups. Intervention: Participation in a learning collaborative project based on the Breakthrough Series methodology of continuous quality improvement. Main Outcome Measures: Change from baseline in the proportion of children with persistent asthma who received appropriate medication therapy for asthma, and in the proportion of children whose parent received a written management plan for their child's asthma, as determined by telephone interviews with parents of 631 children. Results: After adjusting for state, practice size, child age, sex, and within-practice clustering, no overall effect of the intervention was found. Conclusions: This methodologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on processes or outcomes of care for children with asthma. Potential deficiencies in program implementation, project duration, sample selection, and data sources preclude making the general inference that this type of improvement program is ineffective. Additional rigorous studies should be undertaken under more optimal settings to assess the efficacy of this method for improving care.