26508
document
A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma . 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 .
26509
Intervention_Other
clinician feedback
26510
Intervention_Educational
patient feedback
26511
Intervention_Other
a letter
26512
Intervention_Other
bimonthly telephone call to collect clinical information about the child 's asthma
26513
Intervention_Other
bimonthly computer-generated letters
26514
Intervention_Pharmacological
Asthma medications
26515
Intervention_Control
control
26516
Intervention_Other
Patient-specific feedback
26517
Outcome_Physical
number of symptom days
26518
Outcome_Other
emergency department visits
26519
Outcome_Other
emergency department visits
26520
Participant_Condition
asthma
26521
Participant_Age
5- to 11-year-old
26522
Participant_Sample-size
937