Efforts that enable patients to self-manage and self-monitor their symptoms are the most effective for improving asthma outcomes, according to a new report from the Stanford University-UCSF Evidence-Based Practice Center, funded by the Agency for Healthcare Research and Quality. Interventions that involved more interaction with health care providers in terms of frequency or intensity and that utilized multiple methods of instruction, such as group sessions and role-playing, tended to have the greatest benefits for asthma patients.

"For all the educational interventions, there were some common themes to successful interventions and strategies," said Dena M. Bravata, senior research associate at the Center for Health Policy and Center for Primary Care and Outcomes Research and lead author of the study. "The effective interventions included components that were well-grounded in the theory of behavior change."

To perform a comprehensive review of the scientific literature on interventions for the management of asthma, the investigators analyzed 200 studies in detail -- 72 from the United States and 127 from foreign countries -- after sifting through over 3,800 potentially relevant studies.

The researchers found that among the youngest children, strategies were most effective when parents, caregivers, school nurses, and school personnel were involved in making sure children took the necessary steps to control their symptoms. In adult populations, additional asthma education beyond that done in the course of usual care improved asthma management. For example, such strategies include creating an asthma clinic within the physician's practice or adding pharmacists to the care team.

Asthma is a common condition in the United States, with 16 million adults and 6.1 million children being affected currently. It is the most common chronic condition in children, and it is estimated that asthma-related health care costs will rise to $18 billion by 2020.

The asthma report is the fifth volume in a series of reports from AHRQ's Stanford University-UCSF Evidence-Based Practice Center that evaluate quality improvement strategies for diseases that the Institute of Medicine has identified as key areas where a quality gap exists. For these diseases, best practices for care are known but often not implemented in practice. Quality improvement interventions aim to implement best practices in diverse clinical settings.

The AHRQ report, "Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies for Asthma Care," can be found online. Copies are available by calling the AHRQ Publications Clearinghouse at 800-358-9295 or by sending an e-mail to ahrqpubs@ahrq.hhs.gov.