A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma

Meyer Kattan, Ellen F. Crain, Suzanne Steinbach, Cynthia M. Visness, Michelle Walter, James W. Stout, Richard Evans, Ernestine Smartt, Rebecca S. Gruchalla, Wayne J. Morgan, George T. O'Connor, Herman E. Mitchell

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

CONTEXT. Barriers impede translating recommendations for asthma treatment into practice, particularly in inner cities where asthma morbidity is highest. METHODS. The purpose of this study was to test the effectiveness of timely patient feedback in the form of a letter providing recent patient-specific symptoms, medication, and health service use combined with guideline-based recommendations for changes in therapy on improving the quality of asthma care by inner-city primary care providers and on resultant asthma morbidity. This was a randomized, controlled clinical trial in 5- to 11-year-old children (n = 937) with moderate to severe asthma receiving health care in hospital- and community-based clinics and private practices in 7 inner-city urban areas. The caretaker of each child received a bimonthly telephone call to collect clinical information about the child's asthma. For a full year, the providers of intervention group children received bimonthly computer-generated letters based on these calls summarizing the child's asthma symptoms, health service use, and medication use with a corresponding recommendation to step up or step down medications. We measured the number and proportion of scheduled visits resulting in stepping up of medications, asthma symptoms (2-week recall), and health care use (2-month recall). RESULTS. In this population, only a modest proportion of children whose symptoms warranted a medication increase actually had a scheduled visit to reevaluate their asthma treatment. However, in the 2-month interval after receipt of a step-up letter, 17.1% of the letters were followed by scheduled visits in the intervention group compared with scheduled visits 12.3% of the time by the control children with comparable clinical symptoms. Asthma medications were stepped up when indicated after 46.0% of these visits in the intervention group compared with 35.6% in the control group, and when asthma symptoms warranted a step up in therapy, medication changes occurred earlier among the intervention children. Among children whose medications were stepped up at any time during the 12-month study period, those in the intervention group experienced 22.1% fewer symptom days and 37.9% fewer school days missed. The intention-to-treat analysis showed no difference over the intervention year in the number of symptom days, yet there was a trend toward fewer days of limited activity and a significant decrease in emergency department visits by the intervention group compared with controls. This 24% drop in emergency department visits resulted in an intervention that was cost saving in its first year. CONCLUSIONS. Patient-specific feedback to inner-city providers increased scheduled asthma visits, increased asthma visits in which medications were stepped up when clinically indicated, and reduced emergency department visits.

Original languageEnglish (US)
JournalPediatrics
Volume117
Issue number6
DOIs
StatePublished - Jun 2006

Fingerprint

Quality of Health Care
Asthma
Randomized Controlled Trials
Hospital Emergency Service
Health Services
Morbidity
Delivery of Health Care
Intention to Treat Analysis
Private Practice
Therapeutics
Telephone
Primary Health Care

Keywords

  • Access to care
  • Asthma
  • Clinical trial
  • Inner city
  • Provider feedback

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kattan, M., Crain, E. F., Steinbach, S., Visness, C. M., Walter, M., Stout, J. W., ... Mitchell, H. E. (2006). A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. Pediatrics, 117(6). https://doi.org/10.1542/peds.2005-2160

A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. / Kattan, Meyer; Crain, Ellen F.; Steinbach, Suzanne; Visness, Cynthia M.; Walter, Michelle; Stout, James W.; Evans, Richard; Smartt, Ernestine; Gruchalla, Rebecca S.; Morgan, Wayne J.; O'Connor, George T.; Mitchell, Herman E.

In: Pediatrics, Vol. 117, No. 6, 06.2006.

Research output: Contribution to journalArticle

Kattan, M, Crain, EF, Steinbach, S, Visness, CM, Walter, M, Stout, JW, Evans, R, Smartt, E, Gruchalla, RS, Morgan, WJ, O'Connor, GT & Mitchell, HE 2006, 'A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma', Pediatrics, vol. 117, no. 6. https://doi.org/10.1542/peds.2005-2160
Kattan, Meyer ; Crain, Ellen F. ; Steinbach, Suzanne ; Visness, Cynthia M. ; Walter, Michelle ; Stout, James W. ; Evans, Richard ; Smartt, Ernestine ; Gruchalla, Rebecca S. ; Morgan, Wayne J. ; O'Connor, George T. ; Mitchell, Herman E. / A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. In: Pediatrics. 2006 ; Vol. 117, No. 6.
@article{f5ce800c56b04379ad613edbdf649ff1,
title = "A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma",
abstract = "CONTEXT. Barriers impede translating recommendations for asthma treatment into practice, particularly in inner cities where asthma morbidity is highest. METHODS. The purpose of this study was to test the effectiveness of timely patient feedback in the form of a letter providing recent patient-specific symptoms, medication, and health service use combined with guideline-based recommendations for changes in therapy on improving the quality of asthma care by inner-city primary care providers and on resultant asthma morbidity. This was a randomized, controlled clinical trial in 5- to 11-year-old children (n = 937) with moderate to severe asthma receiving health care in hospital- and community-based clinics and private practices in 7 inner-city urban areas. The caretaker of each child received a bimonthly telephone call to collect clinical information about the child's asthma. For a full year, the providers of intervention group children received bimonthly computer-generated letters based on these calls summarizing the child's asthma symptoms, health service use, and medication use with a corresponding recommendation to step up or step down medications. We measured the number and proportion of scheduled visits resulting in stepping up of medications, asthma symptoms (2-week recall), and health care use (2-month recall). RESULTS. In this population, only a modest proportion of children whose symptoms warranted a medication increase actually had a scheduled visit to reevaluate their asthma treatment. However, in the 2-month interval after receipt of a step-up letter, 17.1{\%} of the letters were followed by scheduled visits in the intervention group compared with scheduled visits 12.3{\%} of the time by the control children with comparable clinical symptoms. Asthma medications were stepped up when indicated after 46.0{\%} of these visits in the intervention group compared with 35.6{\%} in the control group, and when asthma symptoms warranted a step up in therapy, medication changes occurred earlier among the intervention children. Among children whose medications were stepped up at any time during the 12-month study period, those in the intervention group experienced 22.1{\%} fewer symptom days and 37.9{\%} fewer school days missed. The intention-to-treat analysis showed no difference over the intervention year in the number of symptom days, yet there was a trend toward fewer days of limited activity and a significant decrease in emergency department visits by the intervention group compared with controls. This 24{\%} drop in emergency department visits resulted in an intervention that was cost saving in its first year. CONCLUSIONS. Patient-specific feedback to inner-city providers increased scheduled asthma visits, increased asthma visits in which medications were stepped up when clinically indicated, and reduced emergency department visits.",
keywords = "Access to care, Asthma, Clinical trial, Inner city, Provider feedback",
author = "Meyer Kattan and Crain, {Ellen F.} and Suzanne Steinbach and Visness, {Cynthia M.} and Michelle Walter and Stout, {James W.} and Richard Evans and Ernestine Smartt and Gruchalla, {Rebecca S.} and Morgan, {Wayne J.} and O'Connor, {George T.} and Mitchell, {Herman E.}",
year = "2006",
month = "6",
doi = "10.1542/peds.2005-2160",
language = "English (US)",
volume = "117",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

TY - JOUR

T1 - A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma

AU - Kattan, Meyer

AU - Crain, Ellen F.

AU - Steinbach, Suzanne

AU - Visness, Cynthia M.

AU - Walter, Michelle

AU - Stout, James W.

AU - Evans, Richard

AU - Smartt, Ernestine

AU - Gruchalla, Rebecca S.

AU - Morgan, Wayne J.

AU - O'Connor, George T.

AU - Mitchell, Herman E.

PY - 2006/6

Y1 - 2006/6

N2 - CONTEXT. Barriers impede translating recommendations for asthma treatment into practice, particularly in inner cities where asthma morbidity is highest. METHODS. The purpose of this study was to test the effectiveness of timely patient feedback in the form of a letter providing recent patient-specific symptoms, medication, and health service use combined with guideline-based recommendations for changes in therapy on improving the quality of asthma care by inner-city primary care providers and on resultant asthma morbidity. This was a randomized, controlled clinical trial in 5- to 11-year-old children (n = 937) with moderate to severe asthma receiving health care in hospital- and community-based clinics and private practices in 7 inner-city urban areas. The caretaker of each child received a bimonthly telephone call to collect clinical information about the child's asthma. For a full year, the providers of intervention group children received bimonthly computer-generated letters based on these calls summarizing the child's asthma symptoms, health service use, and medication use with a corresponding recommendation to step up or step down medications. We measured the number and proportion of scheduled visits resulting in stepping up of medications, asthma symptoms (2-week recall), and health care use (2-month recall). RESULTS. In this population, only a modest proportion of children whose symptoms warranted a medication increase actually had a scheduled visit to reevaluate their asthma treatment. However, in the 2-month interval after receipt of a step-up letter, 17.1% of the letters were followed by scheduled visits in the intervention group compared with scheduled visits 12.3% of the time by the control children with comparable clinical symptoms. Asthma medications were stepped up when indicated after 46.0% of these visits in the intervention group compared with 35.6% in the control group, and when asthma symptoms warranted a step up in therapy, medication changes occurred earlier among the intervention children. Among children whose medications were stepped up at any time during the 12-month study period, those in the intervention group experienced 22.1% fewer symptom days and 37.9% fewer school days missed. The intention-to-treat analysis showed no difference over the intervention year in the number of symptom days, yet there was a trend toward fewer days of limited activity and a significant decrease in emergency department visits by the intervention group compared with controls. This 24% drop in emergency department visits resulted in an intervention that was cost saving in its first year. CONCLUSIONS. Patient-specific feedback to inner-city providers increased scheduled asthma visits, increased asthma visits in which medications were stepped up when clinically indicated, and reduced emergency department visits.

AB - CONTEXT. Barriers impede translating recommendations for asthma treatment into practice, particularly in inner cities where asthma morbidity is highest. METHODS. The purpose of this study was to test the effectiveness of timely patient feedback in the form of a letter providing recent patient-specific symptoms, medication, and health service use combined with guideline-based recommendations for changes in therapy on improving the quality of asthma care by inner-city primary care providers and on resultant asthma morbidity. This was a randomized, controlled clinical trial in 5- to 11-year-old children (n = 937) with moderate to severe asthma receiving health care in hospital- and community-based clinics and private practices in 7 inner-city urban areas. The caretaker of each child received a bimonthly telephone call to collect clinical information about the child's asthma. For a full year, the providers of intervention group children received bimonthly computer-generated letters based on these calls summarizing the child's asthma symptoms, health service use, and medication use with a corresponding recommendation to step up or step down medications. We measured the number and proportion of scheduled visits resulting in stepping up of medications, asthma symptoms (2-week recall), and health care use (2-month recall). RESULTS. In this population, only a modest proportion of children whose symptoms warranted a medication increase actually had a scheduled visit to reevaluate their asthma treatment. However, in the 2-month interval after receipt of a step-up letter, 17.1% of the letters were followed by scheduled visits in the intervention group compared with scheduled visits 12.3% of the time by the control children with comparable clinical symptoms. Asthma medications were stepped up when indicated after 46.0% of these visits in the intervention group compared with 35.6% in the control group, and when asthma symptoms warranted a step up in therapy, medication changes occurred earlier among the intervention children. Among children whose medications were stepped up at any time during the 12-month study period, those in the intervention group experienced 22.1% fewer symptom days and 37.9% fewer school days missed. The intention-to-treat analysis showed no difference over the intervention year in the number of symptom days, yet there was a trend toward fewer days of limited activity and a significant decrease in emergency department visits by the intervention group compared with controls. This 24% drop in emergency department visits resulted in an intervention that was cost saving in its first year. CONCLUSIONS. Patient-specific feedback to inner-city providers increased scheduled asthma visits, increased asthma visits in which medications were stepped up when clinically indicated, and reduced emergency department visits.

KW - Access to care

KW - Asthma

KW - Clinical trial

KW - Inner city

KW - Provider feedback

UR - http://www.scopus.com/inward/record.url?scp=33745312793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745312793&partnerID=8YFLogxK

U2 - 10.1542/peds.2005-2160

DO - 10.1542/peds.2005-2160

M3 - Article

C2 - 16740812

AN - SCOPUS:33745312793

VL - 117

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 6

ER -