A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care: health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study

Archives of Pediatrics & Adolescent Medicine
Paula LozanoKevin B Weiss

Abstract

Traditional primary care practice change approaches have not led to full implementation of national asthma guidelines. To evaluate the effectiveness of 2 asthma care improvement strategies in primary care. Two-year randomized controlled clinical trial. Forty-two primary care pediatric practices affiliated with 4 managed care organizations. Children aged 3 to 17 years with mild to moderate persistent asthma enrolled in primary care practices affiliated with managed care organizations. Peer leader education consisted of training 1 physician per practice in asthma guidelines and peer teaching methods. Planned care combined the peer leader program with nurse-mediated organizational change through planned visits with assessments, care planning, and self-management support, in collaboration with physicians. Analyses compared each intervention with usual care. Annualized asthma symptom days, asthma-specific functional health status (Children's Health Survey for Asthma), and frequency of brief oral steroid courses (bursts). Six hundred thirty-eight children completed baseline evaluations, representing 64% of those screened and eligible. Mean +/- SD age was 9.4 +/- 3.5 years; 60% were boys. Three hundred fifty (55%) were taking controll...Continue Reading

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