Improving Asthma Management Through a Quality Improvement Program: The CARE4ALL Study.

Abstract

Asthma control in China has been suboptimal, partly attributed to low awareness of and adherence to evidence-based best practice among some Chinese physicians. CARE4ALL (NCT05440097) aimed to improve domestic asthma control through a quality improvement program (QIP) by aligning physicians' clinical practice with Global Initiative for Asthma (GINA) recommendations. This prospective multicenter, single-arm study enrolled 1,500 patients from 31 tertiary or secondary hospitals across China. The QIP started with comprehensive GINA education for pulmonologists and specialist nurses, followed by regular reinforcement sessions over the 48-week study period. The primary end point was the change from baseline at week 48 in the proportion of patients using ICS-based maintenance or reliever medications. At week 48, the proportion of patients using ICS-based medications increased by 12.8% from baseline (odds ratio = 1.761; 95% CI, 1.497-2.072; P < .0001). Asthma control improved substantially, and 56.6% of patients had well-controlled asthma at week 48, an increase of 30.5% from baseline. Patients' quality of life and lung function showed significant improvements at the end of the QIP. Older age, having self-reported asthma triggers, occupational exposures, and poor treatment adherence were potential risk factors for poor asthma control at the study's end. Poor lung function and severe or frequent symptoms were associated with poor asthma outcomes. The QIP effectively enhanced asthma management in China by increasing physicians' adherence to GINA recommendations, which consequently improved patient outcomes. This QIP could serve as a standard model for nationwide implementation to enhance asthma care in China.