Although purchasers, regulators, and advocates exert considerable pressure on care delivery organizations to improve the quality of health care services, few approaches to quality improvement (QI) have been rigorously demonstrated to improve care. Information is particularly needed on the relative effectiveness and cost- effectiveness of different approaches to improving outpatient care. We propose to take advantage of the planned initiation of a disease management program for childhood asthma in a Boston-based integrated delivery system by simultaneously implementing an office-based QI strategy in different practices in the same system, and to assess via a randomized design their relative effectiveness and cost-effectiveness in improving processes and outcomes of care. After each intervention has been in place for one year, we will offer the complementary intervention to the practice, to determine the marginal benefits and costs that each approach offers. Data will be derived from a parent telephone survey, a provider survey and a computerized claims databases for those children in the integrated delivery system with asthma who are covered by one of three large managed care organizations.
The specific aims of the study are to: 1. establish a practice based quality improvement program in a large managed care organization, 2. determine how this strategy, when compared with a disease management strategy that targets high cost patients, affects specified processes of care, health care outcomes, and health care costs for children with asthma, and 3. assess the relative cost-effectiveness of these two approaches.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS010411-03
Application #
6477043
Study Section
Special Emphasis Panel (ZHS1-HCPR-C (03))
Program Officer
Keyes, Marge
Project Start
1999-09-30
Project End
2003-11-30
Budget Start
2001-12-01
Budget End
2003-11-30
Support Year
3
Fiscal Year
2002
Total Cost
Indirect Cost
Name
Institute for Healthcare Improvement
Department
Type
DUNS #
City
Cambridge
State
MA
Country
United States
Zip Code
02138