Objective: To test a quality improvement intervention, a learning collaborativ e based on the Institute for Healthcare Improvement’s Breakthrough Series metho dology, specifically intended to improve care and outcomes for patients with chi ldhood asthma. Design: Randomized trial in primary care practices. Setting: Prac tices in greater Boston, Mass, and greater Detroit, Mich. Participants: Forty-t hree practices, with 13878 pediatric patients with asthma, randomized to interve ntion and control groups. Intervention: Participation in a learning collaborativ e project based on the Breakthrough Series methodology of continuous quality imp rovement. Main Outcome Measures: Change from baseline in the proportion of child ren with persistent asthma who received appropriate medication therapy for asthm a, and in the proportion of children whose parent received a written management plan for their child’s asthma, as determined by telephone interviews with paren ts of 631 children. Results: After adjusting for state, practice size, child age , sex, and within-practice clustering, no overall effect of the intervention wa s found. Conclusions: This methodologically rigorous assessment of a widely used quality improvement technique did not demonstrate a significant effect on proce sses or outcomes of care for children with asthma. Potential deficiencies in pro gram implementation, project duration, sample selection, and data sources preclu de making the general inference that this type of improvement program is ineffec tive. Additional rigorous studies should be undertaken undermore optimal setting s to assess the efficacy of this method for improving care.
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