Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e644-e650 (doi:10.1542/peds.2006-1749)
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ARTICLE

Effectiveness of a Practice-Based, Multimodal Quality Improvement Intervention for Gastroenteritis Within a Medicaid Managed Care Network

Adam J. Zolotor, MD, MPHa, Greg D. Randolph, MD, MPHb, Julie K. Johnson, PhD, MSPHc,d, Steven Wegner, MD, JDe, Lori Edwards, MPH, APRN, BCf, Carol Powell, MSN, RNg and Megan H. Esporas, BAg

a Departments of Family Medicine
b Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
c Department of Medicine, University of Chicago, Chicago, Illinois
d American Board of Medical Specialties, Evanston, Illinois
e AccessCare, Inc, Morrisville, North Carolina
f Johns Hopkins University School of Nursing, Baltimore, Maryland
g Center for Health Care Quality, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio

OBJECTIVE. Acute gastroenteritis results in 220000 hospitalizations yearly in the United States. The substantial geographic variation in gastroenteritis care, coupled with the evidence of effective treatment of dehydration in nonhospital settings, suggests that the majority of these hospitalizations are avoidable. We sought to decrease hospitalizations for gastroenteritis by using practice-based, multimodal quality improvement methods that target multiple care processes to make them consistent with evidence-based guidelines.

METHODS. We used a controlled before/after study design to evaluate a quality improvement intervention in a 20-practice Medicaid network. All 20 practices participated in continuing education sessions; received free oral rehydration solution, patient education materials, and performance feedback; and participated in a follow-up conference call. Three practices were chosen to develop and pilot office-process changes. These practices formed interdisciplinary teams to develop and test changes and collaborated with project faculty and each other. They shared their learning with the other 17 practices via a conference call and toolkit. We compared before/after gastroenteritis hospital admissions for children <5 years old covered by Medicaid in the intervention practices with all other Medicaid recipients in North Carolina using claims data from 2000–2002.

RESULTS. The 3 high-intensity practices all made numerous changes to care processes. Most of the 17 low-intensity practices reported changes in their gastroenteritis care processes. Gastroenteritis admission rates declined 45% in high-intensity practices and 44% in low-intensity practices during the study compared with 11% in the control practices.

CONCLUSIONS. A practice-based, multimodal quality improvement intervention that targets multiple care processes on the basis of evidence-based guidelines lowered rates of gastroenteritis hospitalization in a Medicaid network. This approach could lower costs attributable to gastroenteritis for Medicaid programs.

Key Words: quality improvement • gastroenteritis

Abbreviations: ORT—oral rehydration therapy • AAP—American Academy of Pediatrics • QI—quality improvement • ORS—oral rehydration salts

Accepted Jan 31, 2007.