Quality Improvement Strategies for Children With Asthma A Systematic Review

被引:56
|
作者
Bravata, Dena M. [1 ]
Gienger, Allison L. [1 ]
Holty, Jon-Erik C. [2 ]
Sundaram, Vandana [1 ,4 ]
Khazeni, Nayer [1 ,2 ]
Wise, Paul H. [1 ,3 ]
McDonald, Kathryn M. [1 ]
Owens, Douglas K. [1 ]
机构
[1] Stanford Univ, Ctr Primary Care & Outcomes Res, Stanford, CA 94305 USA
[2] Stanford Univ, Div Pulm & Crit Care Med, Stanford, CA 94305 USA
[3] Stanford Univ, Dept Pediat, Stanford, CA 94305 USA
[4] VA Palo Alto Hlth Care Syst, Palo Alto, CA USA
来源
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE | 2009年 / 163卷 / 06期
基金
美国医疗保健研究与质量局;
关键词
RANDOMIZED CONTROLLED-TRIAL; SELF-MANAGEMENT EDUCATION; INNER-CITY CHILDREN; WRITTEN ACTION PLANS; LOW-INCOME CHILDREN; PEDIATRIC-ASTHMA; CHILDHOOD ASTHMA; PATIENT-OUTCOMES; HEALTH-EDUCATION; ENVIRONMENTAL INTERVENTION;
D O I
10.1001/archpediatrics.2009.63
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care. Data Sources: Cochrane Effective Practice and Organisation of Care Group database (January 1966 to April 2006), MEDLINE (January 1966 to April 2006), Cochrane Consumers and Communication Group database (January 1966 to May 2006), and bibliographies of retrieved articles. Study Selection: Randomized controlled trials, controlled before-after trials, or interrupted time series trials of English-language QI evaluations. Interventions: Must have included 1 or more QI strategies for the outpatient management of children with asthma. Main Outcome Measures: Clinical status (eg, spirometric measures); functional status (eg, days lost from school); and health services use (eg, hospital admissions). Results: Seventy-nine studies met inclusion criteria: 69 included at least some component of patient education, self-monitoring, or self-management; 13 included some component of organizational change; and 7 included provider education. Self-management interventions increased symptom-free days by approximately 10 days/y (P = .02) and reduced school absenteeism by about 0.1 day/mo (P = .03). Interventions of provider education and those that incorporated organizational changes were likely to report improvements in medication use. Quality improvement interventions that provided multiple educational sessions, had longer durations, and used combinations of instructional modalities were more likely to result in improvements for patients than interventions lacking these characteristics. Conclusions: A variety of QI interventions improve the outcomes and processes of care for children with asthma. Use of similar outcome measures and thorough descriptions of interventions would advance the study of QI for pediatric asthma care.
引用
收藏
页码:572 / 581
页数:10
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