Methods aimed at improving asthma care and outcomes management - A case study

Objectives: To compare the experience of one managed care organization (MCO) [Anthem Blue Cross and Blue Shield Midwest Region] to the experience of a reference group of 15 other MCOs participating in a study designed to test the usefulness of outcomes management information in developing and implementing interventions to improve the quality of care in asthma. Study design: Prospective study. Patients and methods: Adult patients with moderate or severe asthma enrolled in sixteen participating MCOs who completed an initial baseline survey in 1993 and follow-up surveys in 1994 and 1995. Data analyses focused on differences between Anthem and the reference group at each round of data collection as well as longitudinal analyses of changes over time. Results: Baseline data suggested some deficiencies in care at all MCO sites. Cross-sectional comparisons between Anthem and the reference group revealed statistically significant differences in outcomes measures (hospitalization and emergency room visits, canceled activities per month because of asthma, asthma attacks per month, and work days lost in the past month). Improvements in these outcomes were reported over the subsequent two years. Patients at Anthem reported a significantly greater increase in peak flow meter (PFM) possession than did those in the reference group (p = 0.01) which may have resulted from an administrative change that made PFMs a funded item. However, other interventions (e.g. educational programs) may have also contributed to the improvements. Conclusions: This study illustrates the ability of MCOs to collect and use patient-reported outcomes data to monitor and improve patient care. Such information allowed this national group of participating MCOs to identify deficiencies in quality of care provided, design tailored interventions and measure the potential impact of these interventions on patient care.