Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: Washington
A Multisite Randomized Trial of the Effects of Physician Education and Organizational Change in Chronic-Asthma Care
Rush Prudential Health System
Paula Lozano, MD, MPH
The Pediatric Asthma Care Patient Outcomes Research Team II evaluated two asthma care strategies: a peer leader-based physician behavior change intervention (PLE) and a practice-based redesign called the planned asthma care intervention (PACI). The interventions were intended to improve the care provided to children with asthma and their health outcomes.
This was a three-arm, cluster randomized trial conducted in 42 primary care practices in the Seattle, Chicago, and eastern Massachusetts regions. A total of 638 children age 3-17 years with mild to moderate persistent asthma were followed for two years. Practices were randomized to PLE, PACI, or usual care.
The Peer Leader Education intervention consisted of training one physician per practice in asthma guidelines and peer teaching methods. Planned care combined the peer leader program with nurse-mediated organizational change through planned visits with assessments, care planning, and self-management support, in collaboration with physicians.
Analyses compared each intervention with usual care. There was a positive impact on symptom days, medication use, and functional status. The study authors concluded that planned care (nurse-mediated organizational change plus peer leader education) is an effective model for improving asthma care in the primary care setting.
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