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BACKGROUND: Quality improvement (QI) efforts can improve guideline-recommended asthma abstract
care processes in the pediatric office setting. We sought to assess whether practice
participation in an asthma QI collaborative was associated with decreased asthma-related
emergency department (ED) visits.
METHODS: A statewide network of practices participated in a pediatric asthma QI collaborative
from 2015 to 2016. We evaluated asthma-related ED visit rates per 100 child-years for
children ages 3 to 21 years with asthma, using the state’s all-payer claims database. We used
a difference-in-differences approach, with mixed-effects negative binomial regression models
to control for practice and patient covariates. Our main analysis measured the outcome before
(2014) and after (2017) the QI collaborative at fully participating and control practices.
Additional analyses assessed (1) associations during the intervention period (2016) and (2)
associations including practices partially participating in QI collaborative activities.
In the postintervention year (2017), participating practices’ (n = 20) asthma-related
RESULTS:
ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per
100 child-years for control practices (n = 15; difference in differences = 27.3; P = .002).
Within the intervention year (2016), we found no statistically significant differences in
asthma-related ED visit rates compared to controls (difference in differences = 24.3; P = .17).
The analysis including partially participating practices yielded similar results and inferences
to our main analysis.
CONCLUSIONS: Participationin an asthma-focused QI collaborative was associated with decreased
asthma-related ED visit rates. For those considering implementing this type of QI
collaborative, our findings indicate that it takes time to see measurable improvements in ED
visit rates. Further study is warranted regarding QI elements contributing to success for
partial participants.
manuscript; Ms Kill extracted and cleaned data for analysis, helped identify relevant literature for
citing, and drafted sections of the methods; Dr McCulloch supported the statistical analyses and To cite: Harder VS, Shaw JS, McCulloch CE, et al.
guided the display and interpretation of results; Drs Shepard and Robinson were part of the quality Statewide Asthma Learning Collaborative Participation
improvement implementation team and drafted sections of the introduction; Drs Shaw and Cabana and Asthma-Related Emergency Department Use.
helped interpret findings and contributed to the discussion; (Continued) Pediatrics. 2020;146(6):e20200213
Dr Bardach supported the analytic design, helped interpret findings, and contributed to all sections of the manuscript draft; and all authors reviewed and revised
the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.
DOI: https://doi.org/10.1542/peds.2020-0213
Accepted for publication Sep 3, 2020
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