Pediatric Physicians' Organization at Children's, Brookline, Massachusetts;Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; andDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
Pediatric Physicians' Organization at Children's, Brookline, Massachusetts;
Pediatrics. 2014 Jul;134(1):e242-8. doi: 10.1542/peds.2013-2643. Epub 2014 Jun 16.
Pediatricians are required to perform quality improvement for board recertification. We developed an asthma project within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, designed to meet recertification requirements and improve asthma care.
The program was based on the learning collaborative model. We developed practice-based registries of children 5 to 17 years of age with persistent asthma and helped physicians improve processes of asthma care through education, data feedback, and sharing of best practices.
Fifty-six physicians participated in 3 cohorts; 594 patients were included in the project. In all cohorts, improvements occurred in the use of asthma action plans (62.4%-76.8% cohort 1, 50.6%-88.4% cohort 2, 53.0%-79.6% cohort 3) and Asthma Control Tests (4.6%-55.2% cohort 1, 9.0%-67.8% cohort 2, 15.2%-61.4% cohort 3). Less consistent improvements were observed in seasonal influenza vaccines, controller medications, and asthma follow-up visits. The proportion of patients experiencing ≥1 asthma exacerbation within the year declined in all 3 cohorts (37.8%-19.9%, P = .0002 cohort 1; 27.8%-20.7%, P = .1 cohort 2; 36.6%-26.9%, P = .1 cohort 3). For each cohort, asthma exacerbations declined to a greater extent than those of a comparison group.
This asthma quality improvement project designed for maintenance of certification improved processes of care among patients with persistent asthma. The learning collaborative approach may be a useful model for other board-recertification quality improvement projects but requires a substantial investment of organizational time and staff.
儿科医生需要进行质量改进以获得委员会再认证。我们在儿童医疗机构的儿科医生组织内开发了一个哮喘项目，这是一家与波士顿儿童医院相关的独立实践协会，旨在满足再认证要求并改善哮喘护理。
该计划基于学习合作模式。我们为 5 至 17 岁持续性哮喘儿童建立了基于实践的登记处，并通过教育、数据反馈和最佳实践共享帮助医生改善哮喘护理流程。
56 名医生参加了 3 个队列；594 名患者参与了该项目。在所有队列中，哮喘行动计划的使用均有所改善（第 1 队列为 62.4%-76.8%，第 2 队列为 50.6%-88.4%，第 3 队列为 53.0%-79.6%），哮喘控制测试的使用也有所改善（第 1 队列为 4.6%-55.2%，第 2 队列为 9.0%-67.8%，第 3 队列为 15.2%-61.4%）。季节性流感疫苗、控制器药物和哮喘随访的使用情况改善不那么一致。在所有 3 个队列中，一年内经历≥1 次哮喘加重的患者比例均有所下降（第 1 队列为 37.8%-19.9%，P=0.0002；第 2 队列为 27.8%-20.7%，P=0.1；第 3 队列为 36.6%-26.9%，P=0.1）。对于每个队列，哮喘加重的程度都比对照组更严重。
这项针对维持认证的哮喘质量改进项目改善了持续性哮喘患者的护理流程。学习合作方法可能是其他委员会再认证质量改进项目的有用模式，但需要组织投入大量的时间和员工。
