Organizational Change in Pediatric Asthma Care

Source

Lozano, P., Finkelstein, J., Carey, V., Wagner, E., Inui, T., Fuhlbrigge, A., et al. (2004). A Multisite Randomized Trial of the Effects of Physician Education and Organizational Change in Chronic-Asthma Care Health Outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study. JAMA Pediatrics, 158(9), 875-883.

Article Synopsis

This study was designed to "evaluate the effectiveness of two asthma care improvement strategies in primary care" (Lozano et al., 2004, p. 875). The authors studied children from ages 3 to 17 with mild or moderate asthma symptoms from forty-two primary care pediatric practices. The two different care improvement methods studied were peer leader education intervention and a planned care intervention including both peer leaders and organizational change. These were studied against a control group receiving no intervention other than standard care practices of patient educational materials.

The “peer leader education intervention involved training one physician in each practice to be an asthma champion” with specialized knowledge about asthma pharmacology and physician behavioral change strategies (Lozano et al., 2004, p. 877). The physicians were trained by means of workshops, central support by an education coordinator, and a peer learning network. The planned care intervention provided a comprehensive approach including visits with a trained asthma nurse, written materials, and full-day training sessions.

Across a two-year period, the authors found that "an organized approach to pediatric asthma care that includes the services of a nurse plus peer leader education (planned care intervention) can significantly reduce asthma symptom days by 12%, or an average of 13 days per year" (Lozano et al., 2004, p. 880). While this organizational change method was more expensive than the approach only involving education and behavioral change, it also produced more significant results.

Discussion of Organizational Change

This study provides solid information about how organizational change can impact the healthcare of America. While "few primary care-based interventions for pediatric asthma have been proven effective in real-world settings" (Lozano et al., 2004, p. 881), this study found that an organizational change, or planned care, strategy proved effective in reducing asthma symptoms. The planned care model included proactively planned asthma care visits by a trained nurse and physician, feedback reports, care planning, self-management support, and decision support. The results for the organizational change method, while more costly, were far more beneficial for patients than the peer leader education method. "This approach appears to be demonstrating its fruitfulness across settings" (Lozano et al., 2004, p. 881), meaning that the organizational change strategy should be effective in multiple health care settings.

Discussion Questions

1. What are the main differences between the organizational change (planned care) approach to pediatric asthma care and the peer-leader approach?

2. Do you believe that the increase in cost for an organizational change approach, due to the need to bring in specialized nurses, is worth the results? Why or why not?