PT  - JOURNAL ARTICLE
AU  - Kathryn L. Colborn
AU  - Laura Helmkamp
AU  - Bruce G. Bender
AU  - Bethany M. Kwan
AU  - Lisa M. Schilling
AU  - Marion R. Sills
TI  - Colorado Asthma Toolkit Implementation Improves Some Process Measures of Asthma Care
AID  - 10.3122/jabfm.2019.01.180155
DP  - 2019 Jan 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 37--49
VI  - 32
IP  - 1
4099  - http://www.jabfm.org/content/32/1/37.short
4100  - http://www.jabfm.org/content/32/1/37.full
SO  - J Am Board Fam Med2019 Jan 01; 32
AB  - Background: The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes.Objective: To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care practices.Methods: This is an implementation study involving secondary prepost analysis of existing structured clinical, administrative, and claims data. Nine primary care practices in a federally qualified health center network implemented the CATP. Processes of care and health and utilization outcomes were evaluated prepost implementation in a cohort of patients with asthma using generalized linear mixed models.Results: The study cohort included 2678 patients age 5 to 64 years with at least one visit to one of the 9 participating practices during the study period (March 12, 2010 to December 1, 2012). A comparison of 12 months pre- and post-CATP implementation showed improvement in some process measures of asthma care associated with the intervention, including the rate of asthma-severity measurement, although no change in 2 Health care Effectiveness Data and Information Set measures: asthma medication ratio and medication management for people with asthma. We also found no change in asthma outcomes measured across multiple domains: exacerbations, utilization, symptom scores, and pulmonary physiology measures.Conclusions: Implementation of the CATP in a primary care setting led to some improved processes of asthma care, but no changes in measured outcomes. Recommendations for future work include supplemental follow-up training including case review.