Improving the Care of Children With Asthma in Pediatric Practice: The HIPPO Project

Abstract

The care of children with asthma remains suboptimal despite broad consensus among experts on the best approach to diagnosis and management, widespread awareness among child health clinicians of these recommendations, and substantial effort from large health care organizations to improve care and outcomes. This situation mirrors that of immunizations, where both clinicians and public health officials agree on the goals and all desire to achieve excellence, but performance continues to lag.

Many previous interventions to improve care of children with asthma focused on clinician education. A substantial literature highlights the relative importance of traditional educational strategies as a means of improving performance. Another widely used strategy to improve treatment has a third party–an asthma coordinator, a disease manager, or a practice facilitator–identify high-risk patients and either provide substitute care or intervene such that care for the individual is changed. Although this approach may successfully improve treatment of the most severe patients, the fluid nature of asthma morbidity implies that additional children will continue to get suboptimal care and be in need of “rescue.”

We believe a better approach is to focus on improving care int he setting where most children with asthma receive the bulk of their health services–the primary care practice. This focus forms the basis for our initiative, Helping Improve Pediatric Practice Outcomes (HIPPO). HIPPO represents an innovative approach to assisting pediatric practitioners with the implementation of evidence-based recommendations. This initiative is a collaborative undertaking of the Clinical Effectiveness Program at Children’s Hospital, Boston, and the Pediatric Research in Office Settings network of the American Academy of Pediatrics. This article describes the theoretical basis for this approach and how it is working in actual pediatric practices.