Table DSummary of strength of evidence for included studies for KQ2

OutcomesInterventionNo. of Studies/No. of Health Care ProvidersStrength of EvidenceConclusions
ED Visits/HospitalizationsDecision support10/820
4 RCTs, 6 pre-post
ModerateNine of 10 studies reported that decision support interventions reduce ED visits/hospitalizations. The magnitude of effect is large in pre-post studies (5%–60%) and small in RCTs (1%–7%).
Organizational change4/252
2 RCTs, 2 pre-post
LowInconsistent results account for the low strength of evidence for organizational change to reduce ED visits/hospitalizations. Magnitude of effect is large in pre-post studies (41%–54%) and small in RCTs (1%–7%).
Feedback and audit2/125
1 RCT, 1 pre-post
InsufficientNo conclusions could be made because of conflicting results and low magnitude of effect.
Clinical pharmacy support1/36
1 RCT
InsufficientNo conclusion could be made because of imprecise results from one study.
Education only7/343
5 RCTs, 2 pre-post
LowOverall, due to conflicting results among a number of studies, the low strength of evidence suggests that education only interventions do not reduce asthma ED visits and/or hospitalizations.
Magnitude of effect is low. Reductions and increases in ED visits were observed. One study demonstrated significant decreases; in hospitalizations; others showed no change or an increase in hospitalizations (+5 to 10.5%).
Quality improvement and pay-for-performance2/56 practices (providers not reported)
1 RCT, 1 pre-post
LowTwo studies found no significant change in ED visits and hospitalizations. The RCT had evidence of suboptimal practice engagement.
Magnitude of effect is low. ED visits: 5% reduction. Hospitalizations: 2% reduction.
Multicomponent1/17 clinics (providers not reported)
1 cohort
InsufficientThere is insufficient evidence to determine the effect of multicomponent interventions on ED visits/ hospitalizations due to high rates of participant attrition (low study quality) in the single study included.
Information only1/13
1 RCT
InsufficientBased on a single study with a high risk of bias, there is insufficient evidence to determine the effect of information-only interventions on ED visits/hospitalizations.
Missed days of work/schoolDecision support2/435
1 RCT, 1 pre-post
InsufficientThere is insufficient evidence to evaluate the effect of decision support interventions on the number of missed days of work/school due to inconsistent results across the two studies analyzed.
Organizational change1/24
1 RCT
LowOrganizational change does not reduce missed school days from asthma. The strength of evidence for this conclusion is low.
Feedback and audit1/29
1 pre-post
InsufficientThere is insufficient evidence to evaluate the effect of feedback and audit interventions on the number of missed days of work and school from asthma due to inconsistent results and study design.
Clinical pharmacy support0InsufficientNo studies identified.
Education only5/1,767
4 RCTs, 1 pre-post
InsufficientThere is insufficient evidence to evaluate the effect of education only strategies on the number of missed days of work/school from asthma due to imprecise estimates and inconsistent results.
Quality improvement and pay-for-performance1/13 practices (providers not reported)
1 pre-post
InsufficientThere is insufficient evidence to evaluate the effect of quality improvement/pay-for-performance interventions on the number of missed days of work/school from asthma because of high risk of bias in the single study analyzed.
Multicomponent1/17 clinics (providers not reported)
1 cohort
InsufficientThere is insufficient evidence to determine the effect of multicomponent interventions on the number of missed days of work/school from asthma due to risk of bias (high rates of attrition) and inconsistent results across clinical sites.
Information only0InsufficientNo studies identified.

ED = emergency department; RCT = randomized controlled trial

Note: If the number of health care provider participants was not reported for a particular study, the “NR” value was treated as zero for that particular intervention and outcome category.

From: Executive Summary

Cover of Interventions to Modify Health Care Provider Adherence to Asthma Guidelines
Interventions to Modify Health Care Provider Adherence to Asthma Guidelines [Internet].
Comparative Effectiveness Reviews, No. 95.
Okelo SO, Butz AM, Sharma R, et al.

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