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Acad Pediatr. 2018 Sep - Oct;18(7):789-796. doi: 10.1016/j.acap.2018.02.015. Epub 2018 Mar 2.

A Randomized Controlled Trial of an Eczema Care Plan.

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Division of General Pediatrics, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address:
Division of General Pediatrics, Boston, Mass.
Center for Applied Pediatric Quality Metrics, Boston Children's Hospital, Boston, Mass.
Harvard Medical School, Boston, Mass; Dermatology Program, Allergy and Immunology Division, Boston Children's Hospital, Boston, Mass.
Division of General Pediatrics, Boston, Mass; Harvard Medical School, Boston, Mass.



To test whether an eczema care plan (ECP) would improve provider documentation and management, decrease eczema severity, and increase patient quality of life (QOL) in the pediatric primary care setting.


We conducted a randomized controlled trial from June 2015 to September 2016 at a large hospital-based pediatric primary care clinic. Participants included children from 1 month to 16 years of age with a diagnosis of eczema. The intervention group received the ECP and the control group received usual care. Both groups completed a validated eczema severity scale (Patient-Oriented Eczema Measure [POEM]) and a QOL scale (Infant's Dermatitis Quality of Life Index [IDQOL]) or Children's Dermatology Life Quality Index [CDLQI]) before the visit and again ~1 month later.


A total of 211 caregivers completed both the pre- and postintervention surveys (100 control group and 111 intervention group [94% completion]). Intervention group providers were more likely to recommend a comprehensive "step-up" plan (88%) vs 28%; P < .001, bleach baths (45%) vs 9%; P < .001, and wet wraps (50%) vs 7%; P < .001. They were also more likely to document providing a written plan to families (80%) vs 2%; P < .001. In the intervention and control groups, eczema severity and QOL improved between the pre- and postintervention periods. However, there was not a significant difference between the groups on either measure: POEM difference -0.8, 95% confidence interval (CI) -3.2 to 1.7; IDQOL difference -0.1, 95% CI -1.8 to 1.6; CDLQI difference 0.8, 95% CI -0.9 to 2.6.


Intervention group providers documented more comprehensive eczema care than control group providers. Although patients improved on all measures in the postintervention period, the ECP did not augment that improvement.


atopic dermatitis; dermatology; eczema; eczema care plan; primary care


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