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Mathioudakis AG, Tsilochristou O, Adcock IM, Bikov A, Bjermer L, Clini E, Flood B, Herth F, Horvath I, Kalayci O, Papadopoulos NG, Ryan D, Sanchez Garcia S, Correia-de-Sousa J, Tonia T, Pinnock H, Agache I, Janson C. ERS/EAACI statement on adherence to international adult asthma guidelines. Eur Respir Rev 2021; 30:210132. [PMID: 34526316 PMCID: PMC9488124 DOI: 10.1183/16000617.0132-2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/26/2021] [Indexed: 12/20/2022] Open
Abstract
Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties via systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence are most effective in improving guidelines adherence. Differences in outcomes between patients managed by generalists or specialists should be further evaluated.Guidelines need to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimise and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or uncertain diagnosis are needed.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- These authors were Task Force Co-chairs and are equal authors
| | - Olympia Tsilochristou
- Dept of Allergy, Guy's and St Thomas' Foundation Trust, London, UK
- Peter Gorer Dept of Immunobiology, King's College London, London, UK
- These authors were Task Force Co-chairs and are equal authors
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London and the NIHR Imperial Biomedical Research Centre, London, UK
| | - Andras Bikov
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Enrico Clini
- Dept of Medical Specialities, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy
| | - Breda Flood
- European Federation of Allergy and Airways Diseases Patients Association (EFA), Dublin, Ireland
| | - Felix Herth
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ildiko Horvath
- National Koranyi Institute for Pulmonology, Budapest, Hungary
- Institute of Public Health, Semmelweis University, Budapest, Hungary
| | - Omer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
- Allergy Dept, Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Dermot Ryan
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Guimarães, Portugal
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hillary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ioana Agache
- Allergy & Clinical Immunology, Transylvania University, Brasov, Romania
- These authors were Task Force Co-chairs and are equal authors
| | - Christer Janson
- Dept of Medical Science, Respiratory, Allergy and Sleep Research, Uppsala University and University Hospital, Uppsala, Sweden
- These authors were Task Force Co-chairs and are equal authors
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Rojanasarot S, Carlson AM, St Peter WL, Karaca-Mandic P, Wolfson J, Schommer JC. Translational Effect of Provider-Focused, Multi-State, Multi-Clinic Asthma Care Quality Improvement Program on Patient-Level Health Care Costs. J Prim Care Community Health 2021; 12:21501327211000246. [PMID: 33749359 PMCID: PMC7983490 DOI: 10.1177/21501327211000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Enhancing Care for Patients with Asthma (ECPA), a year-long provider-focused, multi-state, multi-clinic quality improvement program, decreased avoidable utilizations among patients with asthma, but its effects on health care expenditures were not determined. This study examined the translational and sustainable effects of improved care through ECPA on individual-level total health care costs due to asthma. METHODS We conducted a retrospective pretest-posttest quasi-experimental study in which attributed 1683 patients in a 12-month pre-ECPA implementation period served as their own control. We constructed the total annual asthma-related health care costs per patient occurred during pre-ECPA implementation, ECPA implementation, and post-ECPA completion. We used 3-level generalized linear mixed models (GLMMs) to estimate the ECPA effect on the annual health care costs and account for correlation between the repeated outcome measures for each patient and nested clinic. All costs were adjusted for inflation to 2014 U.S. dollars, the last year of program observation. RESULTS Total asthma-related health care costs among the 1683 included patients decreased from an average of $7033 to $3237 per person-year (pre-ECPA implementation vs implementation). Using the cost data from the 12-month pre-ECPA implementation period as a reference, GLMMs found that the ECPA implementation was associated with a reduction in total annual asthma-related health care costs by 56.4% (95% CI -60.7%, -51.8%). During the 12-months after ECPA completion period, health care costs were also found to be significantly lower, experiencing a 57.3% reduction. CONCLUSIONS The economic benefits of ECPA provide a justification to adopt this quality improvement initiative to more primary care clinics at a national level.
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Affiliation(s)
- Sirikan Rojanasarot
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angeline M Carlson
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Data Intelligence Consultants LLC, Eden Prairie, MN, USA
| | - Wendy L St Peter
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Pinar Karaca-Mandic
- Department of Finance, Carlson School of Management, University of Minnesota, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jon C Schommer
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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Perkins A, Bradley A, Magaldi J. Case analyses of state-sponsored asthma quality improvement interventions - benefits and technical assistance efforts. J Asthma 2021; 59:616-627. [PMID: 33287598 DOI: 10.1080/02770903.2020.1861625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A cross-case analysis was used to discover how two states benefited from expanded use of evaluation for asthma quality improvement initiatives. If an asthma quality improvement (QI) initiative is successfully evaluated, data can inform how to effectively integrate clinical practice guidelines and circumvent non-clinical reasons that interrupt QI projects such as low staff interest. This article addresses a gap in the literature on quality of evaluation support needed to improve and sustain asthma QI at local health care organizations by describing the similar discoveries observed at two independent QI statewide initiatives in Indiana and Montana. METHODS As part of a larger review, two states funded through the National Asthma Control Program at the Centers for Disease Control and Prevention were identified based on similarities in evaluation approaches. Each state used an iterative stakeholder-driven evaluation approach, mixed methods, process evaluation indicators, and active use of evaluation findings. The asthma QI initiatives and evaluations in Indiana and Montana were coordinated independent of each other. RESULTS Although both states found that asthma QI initiatives improved health outcomes, evaluation data were able to further pinpoint areas that would improve quality of technical support to health care organizations and identify markers of sustainability, such as nontraditional benefits to staff, and intervention sites. CONCLUSION Findings suggest that when evaluation is used to guide implementation, data are available to develop site-specific assistance and identify sustainability markers to prevent interruption of positive health outcomes associated with an asthma QI initiative.
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Affiliation(s)
- Ayana Perkins
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Bradley
- Montana Department of Public Health and Human Services, Public Health and Safety Division, Helena, MT, USA
| | - Judith Magaldi
- Cancer Control Section, Division of Chronic Disease, Primary Care and Rural Health, Indiana State Department of Health, Indianapolis, IN, USA
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Rojanasarot S, Carlson AM, St Peter WL, Karaca-Mandic P, Wolfson J, Schommer JC. Reducing potentially preventable health events among patients with asthma through multi-state, multi-center quality improvement program. J Asthma 2020; 58:874-882. [PMID: 32162561 DOI: 10.1080/02770903.2020.1741611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Enhancing Care for Patients with Asthma is a multi-state, multi-center quality improvement program developed to augment guideline-based practice among health care providers through Plan-Do-Study-Act cycle. This study examined the association between the implementation of the guideline-based quality improvement program and subsequent changes in asthma-related emergency room visits and hospitalizations. METHODS This retrospective, interrupted time-series study used administrative claims data from a private insurer that provided coverage to patients receiving care from participating health centers (15 centers in New Mexico, Oklahoma, Texas, and Illinois). The 12-month implementation period started in January 2013 for centers in Cohort 1 and October 2013 for centers in Cohort 2. The claims of 1,828 patients with asthma from January 2012 to May 2015 were analyzed. The data included 12-month pre-program implementation, 12-month program implementation, and 5-month post-program completion periods. RESULTS The average number of asthma-related emergency room visits and hospitalizations decreased from 2.22 to 1.38 and 1.97 to 1.04 per 100 patients per month, respectively, in the 12-month pre-implementation period as compared to 12-month implementation period. The results of three-level generalized linear mixed models found that during the 12-month implementation period, patients had 37.7% and 47.1% lower rates of emergency room visits and hospitalizations, respectively, compared to the 12-month pre-implementation period (p < 0.001 in both comparisons). CONCLUSIONS Enhancing Care for Patients with Asthma is an effective quality improvement program that was successfully executed in diverse geographical states and associated with reductions in potentially preventable health events. The findings support the widespread use of the program in other settings.
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Affiliation(s)
- Sirikan Rojanasarot
- Social and Administrative Pharmacy Graduate Program, Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angeline M Carlson
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Wendy L St Peter
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Pinar Karaca-Mandic
- Department of Finance, Carlson School of Management, University of Minnesota, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jon C Schommer
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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