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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.
Arch Pediatr Adolesc Med. 2004 Sep; 158(9):875-83.AP

Abstract

BACKGROUND

Traditional primary care practice change approaches have not led to full implementation of national asthma guidelines.

OBJECTIVE

To evaluate the effectiveness of 2 asthma care improvement strategies in primary care.

DESIGN

Two-year randomized controlled clinical trial.

SETTING

Forty-two primary care pediatric practices affiliated with 4 managed care organizations.

PARTICIPANTS

Children aged 3 to 17 years with mild to moderate persistent asthma enrolled in primary care practices affiliated with managed care organizations.

INTERVENTIONS

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.

MAIN OUTCOME MEASURES

Annualized asthma symptom days, asthma-specific functional health status (Children's Health Survey for Asthma), and frequency of brief oral steroid courses (bursts).

RESULTS

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 controller medication. Mean +/- SD annualized asthma symptom days was 107.4 +/- 122 days. Children in the peer leader arm had 6.5 fewer symptom days per year (95% confidence interval [CI], - 16.9 to 3.6), a nonsignificant difference, but had a 36% (95% CI, 11% to 54%) lower oral steroid burst rate per year compared with children receiving usual care. Children in the planned care arm had 13.3 (95% CI, - 24.7 to -2.1) fewer symptom days annually (-12% from baseline; P =.02) and a 39% (95% CI, 11% to 58%) lower oral steroid burst rate per year relative to usual care. Both interventions showed small, statistically significant effects for 2 of 5 Children's Health Survey for Asthma scales. Planned care subjects had greater controller adherence (parent report) compared with usual care subjects (rate ratio, 1.05 [95% CI, 1.00 to 1.09]).

CONCLUSIONS

Planned care (nurse-mediated organizational change plus peer leader education) is an effective model for improving asthma care in the primary care setting. Peer leader education on its own may also serve as a useful model for improving asthma care, although it is less comprehensive and the treatment effect less pronounced.

Authors+Show Affiliations

Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Seattle, WA 98101, USA. plozano@u.washington.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15351753

Citation

Lozano, Paula, et al. "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, vol. 158, no. 9, 2004, pp. 875-83.
Lozano P, Finkelstein JA, Carey VJ, et al. 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. Arch Pediatr Adolesc Med. 2004;158(9):875-83.
Lozano, P., Finkelstein, J. A., Carey, V. J., Wagner, E. H., Inui, T. S., Fuhlbrigge, A. L., Soumerai, S. B., Sullivan, S. D., Weiss, S. T., & Weiss, K. B. (2004). 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, 158(9), 875-83.
Lozano P, et al. 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. Arch Pediatr Adolesc Med. 2004;158(9):875-83. PubMed PMID: 15351753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Lozano,Paula, AU - Finkelstein,Jonathan A, AU - Carey,Vincent J, AU - Wagner,Edward H, AU - Inui,Thomas S, AU - Fuhlbrigge,Anne L, AU - Soumerai,Stephen B, AU - Sullivan,Sean D, AU - Weiss,Scott T, AU - Weiss,Kevin B, PY - 2004/9/8/pubmed PY - 2004/10/22/medline PY - 2004/9/8/entrez SP - 875 EP - 83 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 158 IS - 9 N2 - BACKGROUND: Traditional primary care practice change approaches have not led to full implementation of national asthma guidelines. OBJECTIVE: To evaluate the effectiveness of 2 asthma care improvement strategies in primary care. DESIGN: Two-year randomized controlled clinical trial. SETTING: Forty-two primary care pediatric practices affiliated with 4 managed care organizations. PARTICIPANTS: Children aged 3 to 17 years with mild to moderate persistent asthma enrolled in primary care practices affiliated with managed care organizations. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: Annualized asthma symptom days, asthma-specific functional health status (Children's Health Survey for Asthma), and frequency of brief oral steroid courses (bursts). RESULTS: 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 controller medication. Mean +/- SD annualized asthma symptom days was 107.4 +/- 122 days. Children in the peer leader arm had 6.5 fewer symptom days per year (95% confidence interval [CI], - 16.9 to 3.6), a nonsignificant difference, but had a 36% (95% CI, 11% to 54%) lower oral steroid burst rate per year compared with children receiving usual care. Children in the planned care arm had 13.3 (95% CI, - 24.7 to -2.1) fewer symptom days annually (-12% from baseline; P =.02) and a 39% (95% CI, 11% to 58%) lower oral steroid burst rate per year relative to usual care. Both interventions showed small, statistically significant effects for 2 of 5 Children's Health Survey for Asthma scales. Planned care subjects had greater controller adherence (parent report) compared with usual care subjects (rate ratio, 1.05 [95% CI, 1.00 to 1.09]). CONCLUSIONS: Planned care (nurse-mediated organizational change plus peer leader education) is an effective model for improving asthma care in the primary care setting. Peer leader education on its own may also serve as a useful model for improving asthma care, although it is less comprehensive and the treatment effect less pronounced. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/15351753/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_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/archpedi.158.9.875 DB - PRIME DP - Unbound Medicine ER -