Variation in managing asthma: Experience at the medical group level in California

Objective: To explore the degree of variation in the quality of asthma mana gement among physician groups participating in a managed care network. Study Design: Cross-sectional observation. Patients and Methods: The study population consisted of patients with moder ate or severe asthma identified through a pharmacy database from a managed care plan in 1996. The patients were surveyed to obtain their assessments o f asthma care, including components on quality of care, quality of service, arid outcomes of care. We selected 47 physician groups that provided servi ces for at least 35 asthma patients who responded to the survey. Variations in the outcome variables across physician groups were described by quartil e, range, and histogram. Results: Compliance with national guidelines varied among physician groups but was generally low. Physician group rates for patient use of steroid inh alers ranged from 10.7% to 45.5% and daily peak flow meter use ranged from 0% to 13.1%. Satisfaction ratings were higher, with overall satisfaction wi th the quality of asthma care ranging from 74.6% to 94.3%. Outcomes also sh owed considerable variation among groups. One-month absenteeism rates range d from 32% to 61%, and 65.7% to 94.3% of respondents did not have an emerge ncy room visit in the past year. Conclusion: The quality of asthma care and service varied significantly acr oss physician groups. Such reports for different physician groups make evid ence-based outcomes information directly available to patients and physicia n groups, help patients make informed healthcare decisions, and stimulate q uality improvement efforts by physician groups.