Grant: Partnerships for Health System Improvement (PHSI)

Asthma is the most common chronic disease in children. Unfortunately many children do not receive optimal therapy based on best evidence. One way to optimize management is to develop clinical pathways which help guide clinicians. A provincial clinical pathway for the management of chronic and acute childhood asthma is being developed. We propose a three year project to implement the asthma pathway in two former Alberta health regions (Peace Country and Palliser) and evaluate its overall impact. Our specific objectives will be: 1. To assess potential barriers to implementing the provincial pathway to facilitate our implementation strategy. 2. To implement the provincial pathway using 'local champions' identified at hospitals within the former Peace and Palliser Regions, an interactive web-based teaching module designed for primary care clinicians, and customized physician order sheets that will serve to remind clinicians of best practice. 3. To evaluate whether the asthma pathway increases the proportion of children treated in emergency departments and primary care clinics with evidenced-based therapies. 4. To evaluate whether the asthma pathway reduces emergency department visits, hospitalizations, and total health system expenditures per child with asthma. 5. To evaluate how many health care workers use the web-based module and what they learn from it. 6. To conduct focus groups of health care workers from a representative sample of Peace Country and Palliser hospitals to elicit a better understanding of why implementation was more successful in some sites than others. 7. To create a continuous quality improvement cycle that will extend indefinitely after the life of this project. This will be possible because decision makers and clinician leaders have been involved in this project from its inception, and it responds directly to their needs and priorities.