Rethinking asthma from business to bedside.

Objective: To explore the possible application of concepts, methods, and tools validated in the worlds of statistics, business, engineering, and system dynamics to improve insight and outcomes in asthma care.

Data Sources: Peer-reviewed articles, books, and other publications on the topic of asthma care, dating back to 1931, were retrieved using MEDLINE searches and other external sources. Searches were restricted to include only studies with human subjects and the English language as descriptors, and the terms used included the following: system dynamics, statistical process control charts, continual improvement, mental models, personal mastery, systems thinking, team learning, and shared vision. Personal author observations and experiences were also included.

Study Selection: Review and original research studies that reported on these concepts were evaluated.

Results: Results show that the concepts behind these models may be transferred to the system of asthma care. Indeed, case studies have shown that control charts can be used to detect signals of improved or declined function in asymptomatic patients, monitor medication adverse effects and the effects of adding a new medication, and evaluate the effectiveness of different medication delivery systems.

Conclusions: These concepts and tools can provide immeasurable value to the process of rethinking and redesigning asthma care. They have the potential to help physicians and patients alike in designing and executing systems of care that are capable of not only delivering better outcomes but also inviting commitment to the long-term care many require.