Impact of quality circles for improvement of asthma care: results of a randomized controlled trial
Open accessAbstract
RATIONALE AND AIMS: Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark. METHODS: Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty-three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs. RESULTS: A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow-up 1 year later. Use of inhaled steroids at baseline was high (69%) and self-management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07-0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5-34.3) and emergency visits (OR 4.9; 95% CI 1.6-14.7). There was no difference between traditional and benchmarking QCs. CONCLUSIONS: Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self-management of asthma patients.
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Schneider 2008 found that identifying top performers in feedback presented in a quality circle did not lead to improvements in management of asthma (adjusted RD = -5%, high risk of bias).
“In contrast, Schneider 2008 found that identifying top performers in feedback presented in a quality circle (i.e. learning collaborative) did not lead to improvements in management of asthma (adjusted RD = ‐5%, high risk of bias).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Schneider 2008
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Audit and feedback: effects on professional practice and healthcare outcomes
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- Authors
- Schneider, A., Wensing, M., Biessecker, K., Quinzler, R., Kaufmann‐Kolle, P., & Szecsenyi, J.
- Affiliations
- University Hospital Heidelberg (DE)
- Corresponding author
- Schneider, Antonius
- Venue
- Journal of Evaluation in Clinical Practice
- Publisher
- Wiley
- Published
- 2007-12-14
- Volume
- 14
- Issue
- 2
- Pages
- 185-190
- ISSN
- 1356-1294 (ISSN-L)
- 1365-2753
- PMC
- PMC2440309
- OpenAlex
- W2115806033
- Cited by
- 44
- References
- 26
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 4 · 2013: 5 · 2012: 6
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Evaluation in Clinical Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Bundesministerium für Gesundheit
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- quality circles, asthma care, benchmarking, general practitioners, quality improvement, guideline adherence, inhaled corticosteroids, asthma self-management, theophylline, asthma education, peak flow meter, patient satisfaction
- MeSH terms
- Asthma, Emergency Service, Hospital, Family Practice, Feedback, Female, Germany, Hospitalization, Humans, Male, Management Quality Circles, Middle Aged, Patient Compliance, Quality Assurance, Health Care, Surveys and Questionnaires, Efficiency, Organizational, Risk Assessment, Benchmarking
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