Enhancing guideline‐based asthma care processes through a multi‐state, multi‐center quality improvement program

Objective: This study investigated the effectiveness of Enhancing Care for Patients with Asthma (ECPA)—a collaborative quality improvement program implemented in 65 community health centers that serve asthma patients in four states—on clinic‐based asthma performance measures consistent with national guidelines. Methods: This study utilized a pretest‐posttest quasi‐experimental design. Six clinic‐based performance measures of each center were collected from a retrospective chart review at time points: before the ECPA implementation; at the end of the 12‐month long ECPA program; and 6 months after program completion. The effectiveness of the ECPA was assessed using generalized linear mixed models with a Poisson distribution and log link by evaluating the change in each measure from baseline to program completion, from baseline to 6‐month post‐program completion and from program completion to 6‐month post‐program completion. Results: The ECPA implementation was positively associated with improvement in all measures from baseline to program completion: documentation of asthma severity (rate ratio (RR) 1.314; 95% confidence interval (CI) 1.206, 1.432); Asthma Control Test (RR 3.625; 95% CI 3.185, 4.124); pulmonary function testing (RR 1.771; 95% CI 1.527, 2.054), asthma education (RR 2.246; 95% CI 2.018, 2.501), asthma action plan (RR 2.335; 95% CI 2.070, 2.634) and controller medication (RR 1.961; 95% CI 1.504,2.556). Improvement was sustained for all six measures at the 6‐month post‐program completion time point. Conclusion: This study demonstrated the favorable effect of the ECPA program on evidence‐based asthma quality measures. This program could be considered a model worth replication on a broader scale.