Effectiveness of Clinical Practice Guidelines for Treating Asthma in the Department of Defense: A Comparison of Clinical and Economic Outcomes Between the Army, Air Force, and Navy

摘要

The purpose of this research was to evaluate the strategy of the military health service (MHS) to improve asthma outcomes through the use of clinical practice guidelines (CPGs). Outcomes were evaluated at the patient level and included inpatient/outpatient visits, prescriptions dispensed, number of exacerbations, number of bed days and direct cost of therapy. In addition, provider compliance to CPO recommendations was evaluated by measuring the proportion of subjects dispensed long-acting controller medications. A nonrandomized control-group before-after design with retrospective matched-pair DoD data was used for this research. The intervention used in this research was the formal asthma CPG-use process implemented by the Army in September of 2000. Compared to baseline measures, all outcomes improved significantly (p <0.05) in the after period for both the subjects exposed, and not exposed, to the CPO-use process. Other than the improvement noted in the number of asthma exacerbations, which was greater in the exposed group than the non-exposed group (p < 0.001), there was no other difference between groups in the amount that outcomes improved. When adjusted for covariates (gender, comorbidity, age, beneficiary status, facility size, TRICARE region, multiple facilities, and treatment received at a lead agent facility), the CPG-use process was associated with a decrease in the direct cost of asthma therapy (-$55.65, p = 0.021). There was no association between the Army CPO-use process and total number of encounters, prescriptions, or beddays. Health care visits (0.12, p <0.001) and exacerbations (OR = 1.22, p <0.001) were significantly higher for those exposed to the CPG-use process as compared to those not exposed.