Statewide Asthma Learning Collaborative Participation and Asthma-related Emergency Department Use

 

Quality improvement (QI) efforts can improve guideline-recommended asthma 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.

 

To do this, we used 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.

 

We found in the postintervention year (2017), participating practices’ (n = 20) asthma-related 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 = −7.3; 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 = −4.3; P = .17). The analysis including partially participating practices yielded similar results and inferences to our main analysis.

 

In conclusion, participation in 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.

 

Citation:

Statewide Asthma Learning Collaborative Participation and Asthma-Related Emergency Department Use

Valerie S. Harder, Judith S. Shaw, Charles E. McCulloch, Lindsay Kill, Keith J. Robinson, Michelle T. Shepard, Michael D. Cabana, Naomi S. Bardach

Pediatrics Dec 2020, 146 (6) e20200213; DOI: 10.1542/peds.2020-0213

Corresponding Author:

Valerie Harder

Pediatric Quality Measures Program

Asthma and sickle cell disease (SCD) are two chronic conditions associated with increased pediatric mortality, morbidity and health care utilization in the United States. The University of California, San Francisco (UCSF), in partnership with the Vermont Child Health Improvement Program (VCHIP), the Pacific Sickle Cell Regional Collaborative (PSCRC) and the California Health Institute has created the “IMPLEmenting MEasures NeTwork (IMPLEMENT) for Child Health.” The IMPLEMENT network will evaluate, in multiple states, two sets of quality measures recently developed by the Pediatric Quality Measures Program (PQMP) in asthma and SCD.

Our Specific Aims are:

Feasibility:  Assess the feasibility of implementing the PQMP measures within the Medicaid patient populations. We will partner with Medicaid or state agencies in 4 states (CA, OR, VT, MA). Feasibility will be based on the measurement burden in implementing the PQMP quality measures and whether significant differences can be measured at the state, health plan, or provider level.

Usability: Assess the usability of the PQMP measures in driving and defining quality improvement (QI) goals for asthma (in CA, VT) and for SCD through the Pacific Sickle Cell Regional Collaborative (in CA, OR, NV, AZ, WA, AK, ID, HI).

Dissemination: Promote the dissemination of our work by submitting the quality measures that meet endorsement criteria to the National Quality Forum (NQF). Use the National Improvement Partnership Network to share our findings.

 

IMPLEMENT for Child Health